Raffaele Parrozzani, Luisa Frizziero, Sara Trainiti, Ilaria Testi, Giacomo Miglionico, Elisabetta Pilotto, Stella Blandamura, Ambrogio Fassina, Edoardo Midena
Aims To report long-term clinical outcome of topical 1% 5-fluoruracil (5-FU) as a sole treatment of ocular surface squamous neoplasia (OSSN).
Methods 41 patients affected by OSSN were included. Each patient underwent full ophthalmological examination at baseline, with cytological or histological confirmation. Patients were treated by topical chemotherapy with 1% 5-FU four times a day for 4 weeks. One course was defined as 4 weeks of topical chemotherapy. Adjunctive courses were administered after 1 month of chemotherapy-free interval.
Results Mean follow-up was 105±32 months (range 60–171 months). Complete tumour regression was achieved in 34 cases (83%) after a mean of 1.5 courses (range, 1–3 courses). Univariate analysis revealed that complete response was significantly related to tumour thickness <1.5 mm (p=0.005), lack of fornix or tarsal involvement (p=0.015 and p=0.009, respectively) and the absence of multifocality (p=0.002). Histopathological diagnosis (intraepithelial neoplasia vs squamous cell carcinoma, p=0.019) and American Joint Committee on Cancer (AJCC) classification (T1 vs T2 or T3) (p=0.028) were also related to incomplete tumour response. In a multivariate analysis, just tumour thickness >1.5 mm (p=0.045) and multifocality (p=0.023) were correlated with incomplete tumour response. Transient and reversible low-to-mild local side effects were documented in 19 (48%) eyes.
Conclusion Topical 5-FU, as a sole therapy, is a long-term safe and effective treatment for patients affected by preinvasive OSSN and for a limited proportion (50%) of invasive OSSN.
Francis L Munier, Pascal Mosimann, Francesco Puccinelli, Marie-Claire Gaillard, Christina Stathopoulos, Susan Houghton, Ciara Bergin, Maja Beck-Popovic
Purpose The introduction of intra-arterial chemotherapy (IAC) as salvage treatment has improved the prognosis for eye conservation in group D retinoblastoma. The aim of this study was to compare the outcomes of consecutive patients with advanced unilateral disease treated with either first-line intravenous chemotherapy (IVC) or first-line IAC.
Design This is a retrospective mono-centric comparative review of consecutive patients.
Patients Sporadic unilateral retinoblastoma group D cases treated conservatively at Jules-Gonin Eye Hospital and CHUV between 1997 and 2014. From January 1997 to August 2008, IVC, combined with focal treatments, was the primary treatment approach. From September 2008 to October 2014, IAC replaced IVC as first-line therapy.
Methods 48 patients met the inclusion criteria, receiving only either IAC or IVC as primary treatment modality.
Results Outcomes of 23 patients treated by IVC were compared with those of 25 treated by IAC; mean follow-up was 105.3 months (range 29.2–218.6) and 41.7 months (range 19.6–89.5), respectively. Treatment duration was significantly shorter in the IAC group (p<0.001). Ten eyes in the IVC group underwent enucleation. Recordable visual acuity of the salvaged eyes was significantly better in the IAC group (0.9 vs 1.4 logarithm of the minimum angle of resolution, p<0.01). No extraocular disease, metastases or long-term systemic complications were observed in either group.
Conclusions The difference in the time frame between treatment groups had an impact on the availability of intravitreal chemotherapy treatment. Despite this, the results reported here imply that eyes treated with first-line IAC will have shorter treatment period, better ocular survival and visual acuity than first-line IVC.
Stephanie M Young, Gangadhara Sundar, Thiam-Chye Lim, Stephanie S Lang, George Thomas, Shantha Amrith
Purpose Bioresorbable implants offer several advantages over permanent implants and serve as a useful alternative in the reconstruction of orbital fractures. Our aim of the study was to evaluate the clinical effectiveness and safety of various bioresorbable implants in the repair of orbital fractures.
Methods A retrospective review of all patients who had undergone orbital fracture repair with bioresorbable implants in a single tertiary trauma centre from January 2005 to December 2014 was performed. Main outcome measures included improvement in ocular motility, diplopia, enophthalmos and infraorbital hypoaesthesia, as well as complication rates.
Results Our study comprised 94 patients and 98 orbits. The types of fractures included orbital floor blow-out fractures (56.1%), zygomaticomaxillary complex fractures (20.4%), combined orbital floor and medial wall fractures (15.3%) and medial wall blow-out fractures (5.1%). The implants evaluated included poly-L/DL-lactide implants (P[L/DL]LA) 85/15 (Rapidsorb), (P[L/DL]LA) 70/30 (PolyMax), polycaprolactone (Osteomesh) and (P[L/DL]LA) 70/30 (MacroPore). There was significant improvement in ocular motility, diplopia, enophthalmos and infraorbital hypoaesthesia postoperatively at week 1, 1 month and 6 months (p<0.001). Comparison of results between the various implants and types of fractures showed no significant difference in postoperative outcome and complications. Late postoperative imaging at 15–24 months showed complete resorption of implants and features of neobone formation in all patients.
Conclusion Our experience with bioresorbable implants shows them to be safe and clinically effective in the reconstruction of orbital fractures.
Hans R Vellara, Richard Hart, Akilesh Gokul, Charles N J McGhee, Dipika V Patel
Background/aims To compare the ocular biomechanical properties in patients with thyroid eye disease (TED) and healthy participants using a non-contact Scheimpflug-based tonometer (CorVis ST).
Methods All eyes were examined by slit lamp biomicroscopy, corneal tomography and the CorVis ST (CST). Patients with TED were examined by a fellowship trained oculoplastics specialist to determine status and assess severity. The outputs from CST and additionally derived parameters, including maximum orbital deformation (MOD), were compared between healthy participants and patients with TED using Student’s t-test. Furthermore, a multiple linear regression analysis was used to control for various factors known to influence ocular biomechanical responses to an air pulse.
Results This study included 20 patients with TED and compared them with a cohort of 152 healthy participants. The mean age of patients with TED was 46.7±19.0 years and the mean age of healthy participants was 35.9±13.8 years (p=0.03). There were no statistically significant differences in gender distributions between both groups (p>0.05). Several CST parameters were significantly different between groups (p<0.05). Of note, however, MOD was significantly lower in patients with TED (0.16±0.04 mm) compared with the healthy participants (0.25±0.05 mm, p<0.001). This dissimilarity remained even after controlling for the various cofactors. Receiver-operating characteristic analysis revealed an area under the curve of 0.91±0.04 (95% CI 0.84 to 0.98, p<0.001) for MOD.
Conclusions The in vivo ocular biomechanics as measured by the CST reflects a reduced orbital compliance. This method of ocular biomechanical assessment may aid in the categorisation of TED severity and assist in monitoring and/or diagnosing TED.