Steven A. McCormick

Population-based incidence of conjunctival melanoma in various races and ethnic groups and comparison with other melanomas.

PURPOSEnTo investigate racial and ethnic differences in the incidence of conjunctival melanoma in a large population-based study.nnnDESIGNnObservational cross-sectional study.nnnMETHODSnUsing data from 1992 through 2003 provided by the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) program, we calculated age-adjusted incidence rates of conjunctival melanoma in various racial and ethnic groups (Black, American Indian, Asian and Pacific Islander, Hispanic, and non-Hispanic White). In addition, we calculated the standard incidence ratios (risk ratios) and 95% confidence intervals to describe the differences within these racial and ethnic groups.nnnRESULTSnFrom 1992 through 2003, there were a total of 168 conjunctival melanomas diagnosed in 13 SEER registries with known racial and ethnic groups. The annual age-adjusted incidence rates (per million population) of conjunctival melanoma was 0.18 (Blacks), 0.17 (American Indians), 0.15 (Asians), 0.33 (Hispanics), and 0.49 (non-Hispanic Whites). The difference in the incidence of conjunctival melanoma between Whites and Blacks or Asians was statistically significant, but was not significant between Blacks and Asians.nnnCONCLUSIONSnThe overall White-to-Black incidence ratio in conjunctival melanoma was 2.6:1, which is much less than that of uveal melanoma (18:1) and cutaneous melanoma (13:1 to 26:1), but is similar to that of mucosal melanoma (2.2:1 to 2.3:1). The cause and significance of this difference of racial and ethnic incidence in various melanomas are discussed.

Shifting trends in in vitro antibiotic susceptibilities for common bacterial conjunctival isolates in the last decade at the New York Eye and Ear Infirmary

BackgroundBacterial conjunctivitis is one of the most common forms of ocular diseases worldwide. The purpose of this study is to determine the most common pathogens causing bacterial conjunctivitis, their in vitro susceptibility to existing antibiotics, and the changing trends in bacterial resistance to antibiotics over the last decade.MethodsRecords of all conjunctival bacterial cultures performed at the NYEEI Microbiology Laboratory from 1 January 1997 through 30 June 2008 were reviewed. Data on species of bacterial isolates and their in vitro susceptibility to the antibiotics tetracycline, trimethaprim/sulfamethoxazole (TMP/SMZ), imipenem, fluoroquinolones (ciprofloxacin, moxifloxacin, gatifloxacin), aminoglycosides (gentamicin, tobramycin), erythromycin, cefazolin, oxacillin, and vancomycin were collected.ResultsReview of records yielded 20,180 conjunctival bacterial cultures, 60.1% of which were culture-positive. Of the culture-positive isolates, 76.6% were gram-positive and 23.4% were gram-negative pathogens. Staphylococcus aureus was the most common gram-positive pathogen isolated, and also the most commonly isolated pathogen overall. Haemophilus influenzae was the most common gram-negative pathogen. A significant increase in the percentage of methicillin-resistant Staphylococcus aureus (MRSA) was observed in the course of 11.5xa0years. The highest levels of antibiotic resistance were observed to tetracycline, erythromycin, and TMP/SMZ. Gram-positive isolates were least resistant to vancomycin, and gram-negative isolates were least resistant to imipenem. The lowest broad-spectrum antibiotic resistance was observed in the case of moxifloxacin, gatifloxacin, and aminoglycosides.ConclusionStaphylococcus aureus is the most common pathogen in bacterial conjunctivitis. Conjunctival bacterial isolates demonstrated high levels of resistance to tetracycline, erythromycin and TMP/SMZ. Moxifloxacin and gatifloxacin appear to be currently the best choice for empirical broad-spectrum coverage. Vancomycin is the best antibiotic for MRSA coverage.

Postkeratoplasty keratoconus in a nonkeratoconus patient

PURPOSEnTo determine whether postkeratoplasty keratoconus is caused by a recurrence of the host disease or transferred from the donor.nnnMETHODSnPenetrating keratoplasty was performed on the right eye of a 73-year-old woman with pseudophakic bullous keratopathy; her other eye was normal. After keratoplasty, visual acuity decreased secondary to the appearance of irregular astigmatism, central corneal thinning, and stromal striae in the graft. A repeat keratoplasty was performed. Clinical corneal topographic analysis and histopathologic studies were performed.nnnRESULTSnClinical findings and histopathology of the corneal graft were consistent with keratoconus. The second graft has remained clear for 2 years without signs of keratoconus.nnnCONCLUSIONnClassic keratoconus developed in a corneal graft in a patient without preexisting keratoconus. This supports the theory that postkeratoplasty keratoconus may be secondary to transfer of the disease from the donor.

The molecular genetics of eyelid tumors: recent advances and future directions

BackgroundUnprecedented recent advances in the molecular genetics of cutaneous malignancies have markedly improved our ability to diagnose, treat, and counsel patients with skin tumors. This review provides an update on molecular genetics of periocular cutaneous basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, Merkel cell carcinoma, and malignant melanoma and describes how the knowledge of molecular genetics is translated into clinical practice.MethodsA literature search of peer-reviewed and indexed publications from 1965 to 2012 using the PubMed search engine was performed. Key terms included: molecular genetics, eyelid, basal cell carcinoma, squamous cell carcinoma, sebaceous adenoma, sebaceous epithelioma, sebaceoma, sebaceous carcinoma, Merkel cell carcinoma, and melanoma. Seminal articles prior to 1965 were selected from primary sources and reviews from the initial search. Articles were chosen based on pertinence to clinical, genetic, and therapeutic topics reviewed in this manuscript.ResultsWe reviewed the literature regarding the advances in molecular genetics of cutaneous basal cell carcinoma, squamous cell carcinoma, sebaceous neoplasia, Merkel cell carcinoma, and malignant melanoma, and possible future directions towards diagnosing and treating cutaneous tumors at the genetic level. Cell culture experiments, animal models, and molecular genetic studies on the patients’ tumor tissues helped to elucidate genetic aberrations in these lesions. Cell culture experiments, animal studies and, ultimately, clinical trials provided means to test and develop novel therapeutic strategies, namely targeted therapy directed at specific molecular genetic defects. While remarkable progress has been made in this process, the complexity of the molecular genetics of skin tumors makes complete elucidation of the genetic mechanisms and the search for ideal therapies challenging.ConclusionsThe recent studies focusing on molecular genetics of cutaneous malignancies show promising results, thereby improving our ability to diagnose, treat and counsel patients with these lesions. Future studies will hopefully help unravel further molecular mechanisms involved in cutaneous neoplasia and provide insights into novel preventative and therapeutic modalities.

Ultrasound biomicroscopic diagnosis of cyclitic membranes

PURPOSEnTo evaluate the utility of ultrasound biomicroscopy in imaging cyclitic membranes.nnnMETHODSnPatients with hypotony and suspected or known cyclitic membrane underwent ultrasound biomicroscopic examination. Histopathology of cyclitic membrane was correlated with ultrasound biomicroscopy in three cases.nnnRESULTSnSix eyes of six patients were enrolled. Mean patient age was 62.2 +/- 18.4 (SD) years. The mean intraocular pressure in the affected eye was 4.3 +/- 3.4 mmHg. Three eyes were pseudophakic and three eyes were aphakic. All eyes had undergone two or more previous intraocular surgeries. Ultrasound biomicroscopy imaged the cyclitic membrane in all six eyes. Histopathology revealed fibroproliferative cyclitic membranes with associated inflammatory cells.nnnCONCLUSIONnUltrasound biomicroscopy is useful in detecting the presence of those cyclitic membranes that may not be identified on clinical examination.

Effect of TGF-β and cAMP-elevating Agents on the Growth of Human Scleral Fibroblasts In Vitro

Previous reports regarding the effects of transforming growth factor (TGF-β) on the growth of fibroblasts have been very conflicting. The present studies indicate that the confusion may be caused by performing studies at different cell densities. At a low cell density (similar to the in vivo situation), TGF-β inhibits the growth of cultured human scleral fibroblasts. Some neurotransmitters or hormones known to influence the development of myopia work through cAMP system. The effect of cAMP on the growth of scierai fibroblasts is not clear. We found that cAMP-elevating agents inhibit the growth of fibroblasts in vitro.

Role of Uveal Melanocytes in the Development of Myopia

Reduction of nitric oxide (NO) may inhibit the development of experimental myopia. Uveal melanocytes reduced the amount of exogenous NO in culture medium provided by a NO donor (S-nitroso-N-acetylpenicillamine, SNAP). Uveal melanocytes have the receptors of various neurotransmitters, melatonin, basic fibroblast growth factor (bFGF) and transforming growth factor-s (TGF-s) and can respond to most of these factors, all of which are known to play a role in the development of myopia. These factors may bind to and modulate the functions of uveal melanocytes and thus influence the development of myopia.

Plasmacytoma associated with canaliculitis

Plasmacytomas are plasma cell neoplasms that rarely involve ocular adnexal tissues as a primary lesion or secondary manifestation of plasma cell myeloma. Only one case of plasmacytoma involving the lacrimal drainage system, to our knowledge, is described in the literature. The clinical presentation of ocular adnexal primary plasmacytoma typically relates to its mass effect. In this clinicopathologic report, we describe an unusual presentation of primary plasmacytoma of the lacrimal canaliculus as infectious canaliculitis.

Hepatocyte Growth Factor Protection of Retinal Pigment Epithelial Cells

Hepatocyte growth factor (HGF) is a pleiotropic growth factor that is mainly expressed in mesenchymal cells. MET (mesenchymal–epithelial transition factor) is a membrane receptor that binds HGF. The receptors for HGF (MET) are primarily found in epithelial cells and several stromal cells. Activation of MET by HGF promotes migration, mitosis, and survival of various cells. HGF protects various cells from oxidative stress-induced apoptosis mainly via the phosphorylation of phosphoinositide 3-kinase/Akt pathway. HGF also plays a role in embryogenesis, tissue repair, and angiogenesis. HGF levels in the ocular fluids are elevated in various ocular diseases related to cell proliferation and angiogenesis. HGF protects retinal pigment epithelial (RPE) cells from hydrogen peroxide-induced apoptosis by inhibition of the mitochondrial apoptotic pathway. In ceramide- and glutathione depletion-induced apoptosis of RPE cells, studies have also demonstrated that HGF can protect RPE cells in these oxidative stress models. These studies suggest that HGF is a natural protective factor for RPE cells and plays an autocrine role protecting RPE cells against oxidative stress.