A rare case of epithelial-myoepithelial carcinoma arising ex pleomorphic adenoma of the lacrimal gland: case report and review of the literature.

A 92-year-old man presented with progressively worsening eye pain, diplopia on lateral gaze and blurred vision for the past 12 months. Radiological imaging confirmed a large left lacrimal gland lesion. The patient subsequently underwent a superio-lateral orbitotomy with left dacryoadenectomy and tumor removal, histopathology subsequently confirmed an epithelial-myoepithelial carcinoma arising ex pleomorphic adenoma of the lacrimal gland. Epithelial-myoepithelial carcinoma is a rare lacrimal gland tumour and the authors believe this case to be the first reported in the Australian population and associated with prolonged eye pain.

Migration of retained tarsal bee stinger onto the ocular surface causing superficial keratopathy.

We report a case of keratopathy due to retained stinger elements following a bee sting and envenomation of the ocular adnexa. A 48-year-old woman presented with a 2-day history of right-sided eye pain, photophobia, and reduced visual acuity. Six days prior to presentation, she had been stung on the right upper eyelid by a bee. Her usual practitioner had removed the stinger and commenced a course of oral antibiotics. Anterior segment examination revealed coarse linear abrasions and superficial punctate keratitis with associated epithelial edema. Eversion of the right upper eyelid revealed the presence of retained stinger lancets near the medial eyelid margin. The retained stinger was removed, and the patient responded well to treatment with topical antibiotics, steroids, and cycloplegia.

Changes in Australian practice patterns for glaucoma management.

IMPORTANCE: The demand for glaucoma care is projected to increase significantly with the ageing population. BACKGROUND: To characterize trends in Australian practice patterns for glaucoma management over the 15-y period between 2003 and 2017. DESIGN: Retrospective audit. SAMPLES: The Medicare eligible population. METHODS: Audit of Medicare Benefits Schedule item number reimbursements in the private healthcare sector, and dispensed Pharmaceutical Benefits Scheme (PBS) prescriptions. MAIN OUTCOME MEASURES: Number, unadjusted cost and services per capita in the enrolled population. RESULTS: The number of medication prescriptions peaked in 2015, but then declined by 14.9%. PBS expenditure on glaucoma medications has been falling since 2012. There was a 9.2-fold increase in fixed-combination prescriptions and 281-fold increase in unpreserved medication prescriptions. In 2017, optometrists generated 1.86% of glaucoma prescriptions. Reimbursements for computerized perimetry increased dramatically for optometrists, and in 2017 optometrist-initiated perimetry exceeded ophthalmologist-initiated perimetry by 35.3%. There were significant increases in laser procedure rates, including laser trabeculoplasty (4.61-fold), laser iridotomy (2.55-fold) and cyclodestructive procedures (2.33-fold). There was a 3.83-fold increase in glaucoma drainage device insertions. Ab interno trabecular microbypass procedures increased 715% from 2014 to 2017. Adjusted for Medicare population, trabecular microbypass is performed at more than twice the rate of primary filtering operations. CONCLUSIONS AND RELEVANCE: This is the first time that glaucoma medication use and expenditure have declined since auditing began in 1992. Glaucoma laser procedures, drainage device implantation and trabecular microbypass increased substantially over the study period. In contrast, the rate of primary filtering operations increased in proportion to population growth. The increase in overall cost of glaucoma care has primarily been driven by computerized perimetry; however, this has been partially offset by a decline in medication expenditure.

Review of paediatric retinal microvascular changes as a predictor of cardiovascular disease.

Recent studies have supported the hypothesis that exposure to established cardiovascular risk factors in early life predisposes to the development of adult cardiovascular disease. Retinal imaging is an emerging technique which facilitates non-invasive, accurate and reproducible assessment of the retinal microvasculature. The assessment may be in the form of static vascular calibre measurements and assessment of the vascular geometry or dynamic structural and functional assessments. Paediatric retinal microvascular changes are reported in response to elevated blood pressure, type 1 diabetes, increasing adiposity, diet, physical activity, systemic inflammation, metabolic peptides, family history and prenatal factors. The resultant microvascular changes have been linked to sub-clinical and overt cardiovascular, cerebrovascular and metabolic disease states in the adult population. Still missing however is longitudinal evidence showing the persistence of retinal microvascular alterations into adulthood. Future studies will enable retinal microvascular assessment to further evaluate the pathogenesis of disease states and response to intervention. The data obtained will also aid in expanding the clinical utility of retinal imaging as a cardiovascular risk prediction and monitoring tool and supplement existing recommendations to reduce cardiovascular morbidity and mortality.

Peripheral ocular aberrations in mild and moderate keratoconus.

PURPOSE: To investigate the influence of keratoconus on peripheral ocular aberrations. METHODS: Aberrations in seven mild and five moderate keratoconics were determined over a 42° horizontal × 32° vertical visual field, with a modified aberrometer. Control data were obtained from an emmetropic group. RESULTS: Most aberrations in the keratoconics showed field dependence, predominately along the vertical meridian. Mean spherical equivalent M, oblique astigmatism J(45), and regular astigmatism J(180) refraction components and total root mean square aberrations (excluding defocus) had high magnitudes in the inferior visual field. The rates of change of aberrations were higher in the moderate than in the mild keratoconics. Coma was the dominant peripheral higher-order aberration in both the emmetropes and the keratoconics; for the latter, it had high magnitudes in the center and periphery of the visual field. CONCLUSIONS: Greater rates of change in aberrations across the visual field occurred in the keratoconus groups than in the emmetropic control group. The moderate keratoconics had more rapid changes in, and higher magnitudes of, aberrations across the visual field than did the mild keratoconics. The dominant higher-order aberration for the keratoconics across the visual field was vertical coma.