Causes and management of sight threatening complications of dermal filler injections: A review.

Injectable dermal fillers continue to increase in popularity in aesthetic medicine. Although rare, vision loss secondary to filler injections is a devastating complication associated with a poor visual prognosis. The mechanism for vision loss is thought to be related to retrograde embolization of the dermal filler from peripheral vessels in the face into the ophthalmic arterial system. Early recognition and prompt management are essential if vision is to be salvaged. The use of retrobulbar hyaluronidase is still contentious, however when administered by a specialist, this treatment gives the best chance at visual recovery and should be considered for all cases.

Periorbital desmoplastic squamous cell carcinoma.

Desmoplasia is the formation of a dense collagenous stroma around a neoplasm. It occurs in a variety of malignancies including squamous cell carcinoma (SCC). While desmoplasia is uncommonly seen in cutaneous SCC, it is an independent risk factor for recurrence and metastasis. We report a case series of desmoplastic SCC in the periorbital region. Seven cases were identified: the median age was 68, four were men. The mean follow-up was 48 months. Two patients (29%) had aggressive local recurrence: one required salvage surgery including orbital exenteration, parotidectomy, and neck dissection to excise involved parotid and cervical lymph nodes; the other required repeat excision and adjuvant radiotherapy. Desmoplastic SCC is an uncommon but highly aggressive subtype. In the periorbital region, due to the high risk of orbital invasion, it is potentially sight and life-threatening.

Improving accessibility to intravitreal anti-vascular endothelial growth factor treatment for ophthalmic patients in a peripheral centre.

AIM: An exponential rise in patients requiring intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment has occurred over recent years. We addressed this in Palmerston North by establishing a senior nurse-led macular review clinic. We aimed to determine the current intravitreal service accessibility and compared it to results from 2012. METHODS: Chart analysis. RESULTS: Planned follow-up was aimed for 42 days, near the end of the anti-VEGF therapeutic effect. It occurred on average at 45.05 (12 to 127) days after initial treatment induction and 40.7 (14 to 77) days for subsequent follow-ups. Treatment was started on average 29.8 (0 to 139) days after the decision was made. Further injections occurred on average 25.7 (0 to 104) days after the retreatment decision. These findings were similar to 2012 where initial follow-up occurred on average 42 (29 to 89) days following treatment, initial treatment 30 (0 to 78) days after treatment decision and retreatment at 34 (6 to 89) days. CONCLUSION: Instituting the senior nurse-led macular review clinic has enabled timely review of patients despite significant increases in those requiring treatment and surveillance. The average follow-up appointment delay is within the four week guideline set by NICE.