Refractive errors after the use of bevacizumab for the treatment of retinopathy of prematurity: 2-year outcomes.

PURPOSE: To evaluate the refractive outcomes in children treated after intravitreal injection of bevacizumab (IVB) for retinopathy of prematurity (ROP). METHODS: A retrospective, bi-centre study of 34 patients (64 eyes) was conducted. The patients were divided into three groups, patients received intravitreal IVB (IVB group), patients received combined IVB and laser treatment (IVB + Laser group), or patients received lens-sparing vitrectomy (IVB + LSV group). Cycloplegic refraction and axial length (AXL) were evaluated at 2 years old. RESULTS: The prevalences of myopia and high myopia were 47.5 and 10.0% in the IVB group, respectively, which were lower than those in the IVB + Laser (82.4 and 29.4%) and IVB + LSV (all 100%) groups (P = 0.001 and P < 0.001). The prevalences of emmetropia in the IVB group, IVB + Laser group, and IVB + LSV group were 50, 5.9, and 0% (P = 0.001). The AXL were similar among all groups. CONCLUSIONS: At the 2-year follow-up, severe ROP patients treated with IVB alone were more likely to remain emmetropic and had lower prevalences of myopia and high myopia. The development of high myopia in severe ROP patients could not be explained by AXL changes but may be associated with abnormalities in the anterior segment.

Eye preservation tectonic graft using glycerol-preserved donor cornea.

AIMS: To report the surgical outcome of tectonic graft using glycerol-preserved donor corneas to treat perforated keratitis. METHODS: The medical records were reviewed of all patients treated for perforated keratitis using glycerol-preserved corneas at a single institution between 1 July 2004 and 31 June 2010. The clinical features, precipitating factors, adjuvant therapies, and therapeutic outcomes were analyzed. Success was defined as re-epithelialization of the ocular surface without evisceration. RESULTS: Fourteen eyes from 14 patients (6 male and 8 female) were included. Age ranged from 58 to 84 years (average, 70.71 ± 8.52 years) and the follow-up time ranged from 7 to 56 months (mean, 25.35 ± 16.84 months). The culture results showed five bacterial infections, five cases of fungal keratitis, and one mixed infection; the culture results were negative for three patients. Satisfactory anatomical integrity was obtained in eight grafts (57.14%) that healed with neovascularization. Six grafts (48.85%) showed delayed re-epithelialization and were repaired with conjunctival flaps to maintain ocular surface integrity. Three patients developed secondary glaucoma and received trans-scleral cyclophotocoagulation. Thirteen patients had satisfactory anatomical integrity without evisceration or exenteration, while one patient received evisceration at 39-month follow-up because of intractable glaucoma. CONCLUSIONS: Glycerol-preserved donor corneas combined with anterior vitrectomy with or without conjunctival flaps may be effective substitutes for evisceration surgery in patients with perforated keratitis.

Paediatric retinal detachment: comparison of high myopia and extreme myopia.

AIMS: To compare the clinical features and surgical outcomes of paediatric retinal detachment (RD) in high myopia and extreme myopia. METHODS: The clinical charts of 107 children who experienced RD and had a spherical equivalent (SE) of at least 6.00 dioptres (D) were reviewed. The patients were separated into a high myopia group (SE -6.0 to -10.0 D) and extreme myopia group (SE >-10.0 D). RD characteristics and outcomes were compared between these two groups. RESULTS: There were significant differences between the two groups in total RD (p<0.001), the presence of posterior staphyloma (p<0.001) and some types of breaks. More eyes in the extreme myopia group required vitrectomy after the initial RD repair. In the high myopia group, retinal reattachment was achieved in 79 eyes (97.5%) at the end of the intervention, whereas in the extreme myopia group, retinal reattachment was achieved in 22 eyes (73.3%). Multiple logistic regression showed that a higher refractive error was the only negative predictor of surgical outcome (p = 0.026). CONCLUSION: Due to differences in aetiologies, clinical characteristics, required surgical procedure after initial repair, surgical and functional outcomes, paediatric RD with extreme myopia should be addressed differently from paediatric RD with high myopia.

Outcome of patients with periocular sebaceous gland carcinoma with and without conjunctival intraepithelial invasion.

PURPOSE: To evaluate the clinical findings, histopathologic features, methods of management, and outcomes in 25 patients with eyelid sebaceous gland carcinoma with and without conjunctival intraepithelial (pagetoid) invasion. PARTICIPANTS: Twenty-five patients with sebaceous gland carcinoma of the periocular region. DESIGN: Retrospective, observational case series. METHODS: The patients were divided into two groups: group A included those with sebaceous gland carcinoma with conjunctival intraepithelial (pagetoid) invasion, and group B included those with sebaceous gland carcinoma without conjunctival intraepithelial invasion. The demographic, clinical, and histopathologic features of sebaceous gland carcinoma were reviewed separately for each group. Ocular management results and systemic prognosis were reviewed. RESULTS: Of the 25 patients, 18 (72%) were females and 7 (28%) were males. The mean age at diagnosis was 65 years (range, 17-90 years). There were 11 patients (44%) in group A, and 14 (56%) in group B. The most common symptom in group A was ocular irritation (45%), and in group B the most common symptom was eyelid lump (86%). The most common sign in group A was diffuse eyelid thickening (72%), and in group B the most common sign was a distinct eyelid mass (43%). Six patients (55%) in group A, compared with one patient (7%) in group B, had both upper and lower eyelid involvement. The most frequent location of tumor epicenter was the outer third of the eyelid in both groups: 37% in group A and 57% in group B. Histopathologic origin of tumor was multicentric in four patients (36%) of group A and six patients (50%) of group B. Before referral, local recurrence had been found in 4 of 12 patients (33%) who underwent surgical treatment elsewhere. After referral, local recurrence was detected in 1 patient (9%) in group A and in 2 patients (14%) in group B. Orbital exenteration was necessary in 4 patients (36%) in group A and in one patient (7%) in group B. Tumor-related metastases occurred in two patients (18%) in group A and in two patients (14%) in group B. CONCLUSIONS: Sebaceous gland carcinoma with conjunctival intraepithelial (pagetoid) invasion has different clinical features compared with that without pagetoid invasion. Conjunctival intraepithelial (pagetoid) invasion carries a higher risk for orbital exenteration, but the risk of tumor-related metastases is similar in both groups.