Yun Hsia, Ching-Yuan Yeh, Yi-Hsuan Wei, Lily-Wei Chen & Shu-Lang Liao
To investigate the clinicopathological features and prognostic factors for eyelid sebaceous gland carcinoma (SGC) in an ethnic Chinese population and to validate the performance of the T category of the 8th edition AJCC staging systems, with the aim of providing information for refinements.
Sixty-three patients with pathological diagnosis of SGC were enrolled retrospectively. The clinicopathological features, treatments, and outcomes were collected. Prognostic factors associated with the outcome of local recurrence, regional lymph node metastasis, and tumour-related death were analysed. The performance analysis was performed by comparing the predictive value for survival and the monotonicity of gradients between the 7th and 8th staging systems.
The distribution of T1:T2:T3:T4 tumours according to the 7th and 8th edition was 6:40:16:1 and 23:26:5:9, respectively. Positive surgical margin was a poor prognostic factor. Local recurrence was associated with more aggressive histopathological features and surrounding structure invasions. Regional lymph node metastasis was associated with larger tumours. The T category of 8th edition showed better predictability for local recurrence and regional lymph node metastasis, while the T category of 7th edition had better monotonicity of gradients. Tumours classified as T2c or worse had higher risk of regional lymph node metastasis, while tumours T3b or worse in the 8th edition had more tumour-related death.
Patients with higher T category are at risk of regional lymph node metastasis and tumour-related death. Further refinement of the T category of AJCC staging system can focus on the predictability for local recurrence and the monotonicity of gradients.
Amit Khedekar, Bharanidharan Devarajan, Kim Ramasamy, Veerappan Muthukkaruppan & Usha Kim
To improve and validate the smartphone-based leukocoria detection application so that non-ophthalmologists could make use of the smartphone for early detection of Retinoblastoma (RB) in young children without anesthesia and pharmacological dilatation of the pupil.
Two apps, MDEyeCare and CRADLE, developed for red reflex based leukocoria detection were used in iPhone 6s. MDEyeCare methodology was modified with respect to ambient lighting, the distance between camera and eye and different gazes for better performance. We analyzed totally 34 eyes of 23 RB patients and four normal children. Each of the RB patients was confirmed with clinical examination and radiological investigations.
Modification in the methodology of MDEyeCare app could detect the leukocoria in early stages of RB (50% of Group B, 83% of Group C). In late stages (Group D and E), 100% of tumors were detected. The CRADLE app failed to provide adequate leukocoria detection except four late stage RB eyes. Among the 14 normal eyes (6 from unilateral RB and eight from normal children), pseudo-leukocoria was observed in three eyes only at lateral gaze even with MDEyeCare app.
Improved methodology in smartphone-based app enhanced the detection of RB and this may translate into better outcome after treatment with respect to vision salvage.
Robi N. Maamari, Philip L. Custer, Michael G. Neimkin & Steven M. Couch
To report the surgical technique and functional outcomes of the medial canthoplasty for the treatment of exposure keratopathy.
An IRB approved, retrospective review of patients who underwent medial canthoplasty for exposure keratopathy was performed. Patient demographics, reported symptoms, and clinical examination findings were collected and analyzed from pre-operative and follow-up visits.
The study included 73 consecutive cases in which the medial canthoplasty was performed in patients with exposure keratopathy. The average follow-up period was 7.9 months (median: 4.7 months; range: 1–150 months). Complete or partial improvement in ocular symptoms (dryness; pain/irritation; tearing) was achieved in 95% (69/73). Clinically, 85% (41/48) of patients demonstrated a post-operative reduction in lagophthalmos and 90% (60/67) showed improvement in ocular surface findings. Complications were rare (1/73) and reversal of medial canthoplasty was not required in any case.
The medial canthoplasty appears to be a safe and effective technique to narrow the palpebral fissure, provide lower eyelid support, and improve keratopathy. It is an uncomplicated procedure that may be considered for the treatment of exposure keratopathy caused by facial paralysis and lower eyelid malposition.
Namrata Gangaram Adulkar, Santhi Radhakrishnan, N. Vidhya & Usha Kim
Invasive sino-orbital fungal infections in immunocompetent patients are a rare clinical entity; the diagnosis and management of which is challenging. We present a large case series of invasive sino-orbital fungal granulomas in patients without pre-existing systemic immunocomprimising condition.
Retrospective case series.
Twenty cases of invasive sino-orbital/naso-orbital fungal granulomas in immunocompetent individuals.
We retrospectively analyzed all patients with orbital fungal granuloma who were treated at a tertiary referral eye center in South India between January 2005 and December 2012. Histopathologic confirmation of tissue invasion by fungal elements and presence of granulomatous inflammation was established in all cases included in the study.
Main outcome measures
Relief of patient symptoms, resolution/no progression of disease on orbital imaging, ocular, and vision salvage were the treatment outcomes studied.
Twenty patients (11 male and 9 female) were studied. Mean age of patients was 47.4 years ranging from 24–65 years. Aspergillus was the causative fungus in 18 cases while 2 were cases of mucormycosis. Surgical debulking of the orbital disease was performed in 7 patients. Exenteration was performed in 2 patients to prevent spread to the CNS. Medical therapy consisted of oral itraconazole in all patients and intravenous amphotericin B was administered in 2 patients. Average duration of medical therapy required to achieve relief from symptoms was 6–8 months. Recurrences are common and long-term follow-up is essential.
Orbital fungal infections are challenging in terms of both diagnosis and treatment. Debulking along with prolonged antifungal therapy seems to be effective in controlling the infection.
Chanjoo Ahn, Sunah Kang & Ho-Seok Sa
To report the outcome of repeated botulinum toxin-A (BTA) injections in the lacrimal glands in patients with epiphora.
We performed retrospective chart review of patients who were injected with 2.5 units of BTA in the lacrimal gland. Epiphora and tear production were assessed by the Munk score and Schirmer-1 test, respectively, pre-injection and at 1 and 3 months post injection. Regarding repeated injections, the effects of the first were compared to those of the second and third injections.
Forty-six eyes of 35 patients had an average of 2.3 injections per eye (range, 1–6). The mean Munk score significantly decreased from 3.72 to 1.87 at 1 month (p < 0.001) and 2.21 at 3 months (p < 0.001) after injection. The mean Schirmer-1 score also significantly decreased from 15.35 mm to 10.52 mm at 1 month (p < 0.001) and 12.48 mm at 3 months (p < 0.001) after injection. The mean reduction rates of Munk and Schirmer-1 scores after the second (66.1% and 29.8%, respectively) and the third injections (56.1% and 23.3%, respectively) were not significantly different from those after the first injection (63.3% and 26.1%, respectively) (p > 0.05 for each comparison). There was a significant correlation between the difficulty in exposing the lacrimal gland for injection and the risk of complication (p = 0.017).
BTA injection in the lacrimal gland showed favourable outcomes; repeated injections did not compromise efficacy. BTA injection can be safely repeated for epiphora, especially in patients whose lacrimal gland can be easily exposed.
Nozomi Matsumura, Toru Suzuki, Satoshi Goto, Takeshi Fujita, Shin Yamane, Maiko Maruyama-Inoue & Kazuaki Kadonosono
To examine the causes of congenital nasolacrimal duct obstruction (CNLDO) using dacryoendoscopy, and to evaluate the surgical outcomes of primary transcanalicular endoscopic dacryoplasty.
The subjects of this study were a total of 56 eyes of 46 Japanese children aged one to five years old (mean, 29.1 ± 14.0 months old) with clinically diagnosed CNLDO. The blockage was visualized and probed using a dacryoendoscope (MD10 with a 20 G probe, Fiber Tech Co., Ltd., Japan) under general anesthesia. We used a self-retaining bicanalicular lacrimal stent (Lacrifast®, Kaneka Co., Ltd., Japan) for nasolacrimal duct intubation.
In each case the obstruction was found to be caused by a single focal blockage at the distal end of the duct. A nasolacrimal dacryolith was observed in 5 eyes (9%) and successfully removed using the dacryoendoscope. The success rate of probing by subsequent nasolacrimal duct intubation was 100%. No complications were observed.
We obtained a 100% success rate with primary transcanalicular endoscopic dacryoplasty for the treatment of CNLDO. Direct visualization inside the lacrimal passage allowed for precise probing, even in infants, leading to successful treatment of CNLDO without any complications.