Michael T. Andreoli

Epidemiological trends in malignant lacrimal gland tumors.

Objective To describe epidemiological trends in lacrimal gland malignancies in the United States. Study Design Retrospective database review. Setting Multicenter registry. Subjects and Methods A total of 702 malignant tumors of the lacrimal gland from the Surveillance, Epidemiology, and End Results database were included in the study. Disease-specific and overall survival were the primary outcome measures. Kaplan-Meier survival curves were generated for multiple patient and tumor characteristics, including race, histology, TNM tumor stage, age at diagnosis, radiotherapy, gender, and tumor grade. Cox proportional hazards regression was performed to assess the impact of patient and tumor characteristics on survival. Results Lymphoma (58.0%), adenoid cystic carcinoma (13.4%), adenocarcinoma (3.8%), and mucoepidermoid carcinoma (3.6%) accounted for most tumors. Lymphoma was associated with more favorable survival rates, while adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma were associated with worse prognosis. There was a steady increase in the proportion of lymphoma diagnosed since 1973. In a multivariate Cox proportional hazards regression model, tumor histology remained as the only covariate correlated with disease-specific survival. Conclusion Patient characteristics and survival rates differ between lymphoma, adenoid cystic carcinoma, adenocarcinoma, and mucoepidermoid carcinoma. The proportion of lacrimal gland cancer diagnosed as lymphoma has steadily increased over time. Cox proportional hazards regression analysis demonstrated tumor histology as one of the most important factors in patient survival. These results augment our understanding of the expected disease course of lacrimal gland malignancies.

PARS PLANA VITRECTOMY COMBINED WITH CATARACT EXTRACTION: A Comparison of Surgical Outcomes Using Single-Piece and Multipiece Foldable Intraocular Lenses.

Purpose: To assess whether complication rates are comparable between phacovitrectomy using multipiece lenses versus single-piece foldable intraocular lenses. Methods: Single-center, multisurgeon retrospective comparative consecutive interventional case series. Two hundred and seventy-one patients undergoing combined phacovitrectomy performed during a single session at a university-based ophthalmology practice from 2004 to 2013 were identified, of whom 184 met study inclusion criteria; 56.4% patients had diabetes mellitus. Results: There was no difference in the total incidences of postoperative complications between combined surgery using single-piece and multipiece intraocular lenses (P = 0.80) or among individual complications between the 2 groups, including synechiae (2.7 vs. 5.3%; P = 0.61), pupillary capture (0.7 and 2.6%; P = 0.36), and lens subluxation (1.4 and 0%; P > 0.99). There was no difference in the incidences of complications in patients with diabetes mellitus compared with nondiabetic patients undergoing phacovitrectomy (P = 0.13). Complication rates did not differ between single-piece and multipiece lenses with the use of postoperative intravitreal tamponade (P = 0.67). Conclusion: Single-piece, acrylic intraocular lenses are associated with a low rate of surgical complications after combined phacovitrectomy and represent an acceptable alternative to multipiece foldable intraocular lenses under the circumstances and using the surgical techniques implemented in this study.

Cotton-Wool Spots and Retinal Hemorrhages

A56-year-oldwomanwithahistoryofcirrhosissecondarytohepa-titisC(diagnosedin2011),hypothyroidism,andanemiapresentedwith6 months of blurred vision in both eyes. Her home medication regi-men consisted of ribavirin, rifaximin, lactulose, furosemide, spirono-lactone,peginterferonalfa-2a,andlevothy-roxinesodium.Correctedvisualacuitywasrecorded as 20/40 OU. Her pupils, intra-ocularpressure,motility,andconfrontationalvisualfieldswerenormalineacheye.Anteriorslitlampexaminationdemonstratedmildnuclearscleroticcataractsinbotheyes.Dilatedfundusexamination(Figure1)demonstratedmultipleperipapillaryandmacularcotton-woolspotsinboth eyes, dot hemorrhages in both eyes, peripapillary flame hemor-rhageintherighteye,andadischemorrhageinthelefteye.

Epidemiological trends in 1452 cases of retinoblastoma from the Surveillance, Epidemiology, and End Results (SEER) registry

OBJECTIVE To assess retinoblastoma epidemiological trends in the Surveillance, Epidemiology, and End Results (SEER) registry. METHODS All cases of retinoblastoma in the SEER database from 1973 to 2009 were identified. Kaplan-Meier survival analyses were performed for pathological grade, patient age, sex, year of diagnosis, and treatment modality. Cox proportional hazards regression assessed the impact of patient and tumour characteristics on survival. RESULTS 1452 cases of retinoblastoma were analyzed. The mean patient age at diagnosis was 1.44 years. The tumour was unilateral in 71.0% and bilateral in 29.0%. The mean follow-up was 129.1 months. Overall survival increased during the study interval. Patients with bilateral tumours were diagnosed at an earlier age (0.46 years) than patients with unilateral disease (1.77 years; p < 0.0001). Bilateral retinoblastoma (90.3% 10-year overall survival) was associated with decreased overall survival than unilateral retinoblastoma (96.1% 10-year overall survival). Bilateral retinoblastoma was also associated with an increased incidence of nonocular malignancies (7.8%) compared with unilateral retinoblastoma (1.3%; p < 0.0001). Grade 1 tumours were diagnosed at a younger age (0.94 years) than grade 3 (2.24 years) and grade 4 tumours (2.14 years; p < 0.0001). Lower grade and lower stage tumours were independently associated with increased survival. In multivariate Cox proportional hazards analysis, T stage and laterality were the only covariates that correlated with overall survival. CONCLUSIONS There appear to be associations between retinoblastoma tumour features such as tumour stage, pathological grade, and laterality with patient characteristics such as age at diagnosis, overall survival, and second malignancies.

Incomplete LASIK Flap

Large-scale studies have reported numerous intraoperative and postoperative laser in situ keratomileusis (LASIK) flap complications with use of a mechanical microkeratome [1]. Frequently, detection of an intraoperative flap complication causes the surgeon to abort the laser ablation process. These eyes then present a management dilemma, as a repeat attempt at refractive surgery is associated with higher risks of intraoperative and postoperative complications [2].