Rehan Rajput, Sandeep Varma & Katya Tambe
We read with interest Saxby et al.’s correspondence regarding their experience of managing periocular basal cell carcinoma (BCC) in the under 40s cohort . Currently our periocular cancer service employs a dermatologist Mohs surgeon for excision followed by reconstruction under the Oculoplastic team. Auditing our own under 40s cohort of patients, we found 11 patients with biopsy proven BCC over a 4-year period with an average age of 32 and mean follow up of 8.5 months. We found 91% (10/11) excisions to be of nodular histological subtype with only one Infiltrative BCC and unlike Saxby et al. found no patients to have morphoeic tumours. A study of 134 patients with <1 cm well demarcated facial BCCs found that 24% required further excision when excised with 2 mm margins . However, it has been shown that 21.8% of all BCCs have a morphoeic or partly morphoeic histology . This may explain why seemingly nodular BCCs may have asymmetric subclinical extensions that result in incomplete excision when 2 mm margins are used. We strongly support their recommendation that Mohs surgery be considered for periocular BCC in the under 40s, especially with the need for complete tumour extirpation and to minimise tissue loss in a cohort with a paucity of skin elasticity where defect repairs can often be challenging.
Bayan Al Othman, Jared Raabe, Ashwini Kini & Andrew G. Lee
This article will review the best approaches to neuroimaging for specific ophthalmologic conditions and discuss characteristic radiographic findings. A review of the current literature was performed to find recommendations for the best approaches and characteristic radiographic findings for various ophthalmologic conditions. Options for imaging continue to grow with modern advances in technology, and ophthalmologists should stay current on the various radiographic techniques available to them, focusing on their strengths and weaknesses for different clinical scenarios.
Xingyi Li, Chang Liu, Zhen Mao, Xuanwei Liang, Zuohong Li, Xuehua Liu, Ruowen Gong & Danping Huang
We studied the difference in the corneal biomechanical parameters of ptotic and fellow eyes in patients with congenital blepharoptosis. The correlations between corneal biomechanical parameters and demographic or ocular parameters, and the changes after surgery were also researched.
The corneal biomechanical parameters were measured by Corvis ST tonometry. The central corneal thickness (CCT), axial length (AL) and keratometry measurements were performed with LenStar LS900, and intraocular pressure (IOP) by non-contact applanation tonometry. The parameters were evaluated for the effect of ptosis and the relationship of corneal biomechanical parameters. These examinations were repeated 6 months after blepharoptosis surgery.
Twenty-nine patients were enroled. The Corvis ST parameters (Deformation amplitude [DA], A1 times, and A1 velocity), CCT, IOP with NCT, IOP with corrected, differed significantly between ptotic and fellow eyes. CCT was significantly positively correlated with Length A1 and IOP with Corvis, and negatively correlated with IOP corrected by Corvis of the ptotic eyes. The same tendency was found in the fellow eyes. Six months after the ptosis surgery, the differences in corneal biomechanics parameters between ptotic eyes and fellow eyes were not significantly changed.
Congenital blepharoptosis causes significant corneal biomechanical changes measured by Corvis ST. The ptotic eyes had thicker and less deformable corneas. The differences in corneal biomechanics between ptotic eyes and fellow eyes were mostly related to CCT changes. Six months after surgery, these differences in corneal biomechanics did not change significantly.