Mucosal-associated lymphoid tissue lymphoma of the conjunctiva.

The recognition of mucosal-associated lymphoid tissue as a distinct entity has lead to the separate classification of tumors arising in this tissue, ie, the mucosal-associated lymphoid tissue lymphoma. Five patients with mucosal-associated lymphoid tissue lymphoma of the conjunctiva are described herein; four of the five patients had bilateral tumors. Laboratory analysis was done using microscopy, immunophenotyping, gene rearrangement analysis using both Southern blot and polymerase chain reaction techniques, and oncogene (bcl-1, bcl-2, and c-myc) rearrangement studies. Typical mucosal-associated lymphoid tissue lymphoma features were seen in all patients; three of four patients who underwent testing with immunphenotyping had light-chain restriction, four of five patients had a clone detected using Southern blot analysis, and all five patients showed clones on polymerase chain reaction analysis. No patient demonstrated oncogene rearrangement. In all patients, complete physical examinations and laboratory tests did not detect any evidence of systemic spread. After treatment, no evidence of local recurrence or dissemination was found during follow-up ranging from 2 to 3 years.

Analysis of the results of surgical endoscopic dacryocystorhinostomy: effect of the level of obstruction.

AIM: One of the main factors in determining success rate of lacrimal surgery is the level of obstruction in the lacrimal drainage system. There are only few reports which quantify this, and none on endoscopic dacryocystorhinostomy (DCR). METHODS: A case series of patients who had endoscopic DCR for anatomical obstruction of the lacrimal drainage system was performed. All patients who had lacrimal blockage referred to a district general hospital, irrespective of the level of blockage, had endoscopic DCR as the initial treatment by the authors. A total of 191 endoscopic DCRs were performed between 1994 and 1999. No other forms of lacrimal surgery were performed during this period. The level of the obstruction was assessed by the ophthalmologist before the operation and confirmed at surgery. All cases were followed up for a minimum of 6 months, and 96 cases were also reviewed 12 months after surgery. The outcome of the endoscopic DCR operation for each eye was categorised into complete cure, partial cure, or no improvement according to the degree of symptomatic relief following the operation. RESULTS: Complete relief from epiphora was achieved in 89% of cases overall at 6 months. The success rate in cases with lacrimal sac/duct obstruction (93%) or common canalicular blockage (88%) was comparable. In canalicular obstruction, however, the complete cure rate was lower at 54%. The benefit of the operation was maintained at 12 months. CONCLUSION: This study demonstrates that the success rate of surgical (non-laser) endoscopic DCR is comparable to that reported for external DCR. Moreover, the technique is appropriate for initial treatment of patients with common canalicular or even canalicular obstruction.

Cryptophthalmos: surgical treatment of the congenital symblepharon variant.

A case of the congenital symblepharon variant of cryptophthalmos is reported. Surgical treatment is described. The ophthalmic features of cryptophthalmos and its systemic associations are reviewed.

Pseudophakic accommodation? A study of the stability of capsular bag supported, one piece, rigid tripod, or soft flexible implants.

A group of pseudophakic patients was investigated to determine whether their implants shift along an anteroposterior axis under different conditions of ciliary muscle stimulation. There was no statistically significant change in refraction after either pilocarpine or cyclopentolate administration. A change in anterior chamber depth between the position after pilocarpine and that after cyclopentolate was found. It appears that rigid posterior chamber implants do move backwards on ciliary muscle relaxation, but by a maximum 0.25 mm. This is not thought to represent a mechanical threat to ocular health. It is also not enough to account for the apparent accommodative ability of some pseudophakic patients. The possible causes for this phenomenon are discussed.

Ipswich lacrimal tube: pedicle nasal septal tube for the reconstruction of lacrimal drainage passage.

Canalicular blockage of the lacrimal system still remains a major challenge for oculoplastic surgeons. The conventional treatment of conjunctival dacryocystorhinostomy using the Lester Jones bypass tube is often associated with tube migration and foreign body reaction. The authors report a new technique to reconstruct the lacrimal passage on a single patient with severe canalicular obstruction following repeated failures from previous Lester Jones tube operations. An epithelial-lined tube was recreated between the nasal cavity and the conjunctiva using a superiorly based mucoperichondrial flap from the nasal septum (Ipswich lacrimal tube). The pedicle of the flap was divided six weeks following the operation. The patient was still symptom free two years following the operation together with a positive dye test confirming the patency of the new lacrimal tube.

Recurrent metastatic breast carcinoma presenting with pansinusitis and choroidal metastases and subsequent bilateral simultaneous orbital cellulitis.

A case report and literature review of a unique presentation of metastatic breast cancer is provided. A 46-year-old patient with a history of breast carcinoma presented with a choroidal mass. Three days later she went on to develop bilateral simultaneous orbital cellulitis, investigation of which revealed underlying bony metastases from a breast primary. In order to diagnose underlying neoplasia, full history and examination is necessary when assessing patients with orbital inflammation.

Endoscopic dacryocystorhinostomy in functional lacrimal obstruction.

INTRODUCTION: We performed endoscopic dacryocystorhinostomy in cases diagnosed with both anatomical and functional lacrimal obstruction, and here report results for the latter cases. METHODS: Sixty-eight endoscopic dacryocystorhinostomies were performed for functional obstruction on 44 patients. The indication for surgery was epiphora in 66 patients and recurrent dacryocystitis in two. The minimum follow up was six months. RESULTS: There was complete cure in 44 (65 per cent) patients, partial cure in nine (13 per cent) and no improvement in 15 (22 per cent). Revision surgery was performed in five of the 15 cases with no improvement, after which there was an overall complete cure in 47 patients (69 per cent), partial cure in 10 (15 per cent) and no improvement in 11 (16 per cent). DISCUSSION: Endoscopic dacryocystorhinostomy is indicated in cases of epiphora with a diagnosis of functional lacrimal obstruction. Currently available investigations cannot reliably distinguish partial anatomical obstruction from pump failure.

Endoscopic inferior dacryocystorhinostomy.

Conventional dacryocystorhinostomy (DCR) usually involves extensive removal of bone at the lacrimal fossa and hence risks disruption of the lacrimal pump mechanism. A physiological operation for nasal lacrimal blockage is described whereby only the inferior portion of the lacrimal sac and the adjacent duct are marsupialized into the nose. The operation is safe, quick and does not involve sophisticated instruments. Result of 81 consecutive endoscopic inferior DCRs reveals a success rate of over 90% which is maintained with time. Most patients had a wide lacrimal window with preserved lacrimal pump movement at the superior sac remnant.

Mucosa-associated lymphoid tissue (MALT) in the human conjunctiva.

The recent description of conjunctival lymphomas with features of lymphomas that arise in mucosa-associated lymphoid tissue (MALT) infers the presence of MALT in the human conjunctiva. Some authors suggest that organized MALT is found in the normal human conjunctiva, but others disagree. In order to resolve this problem, we have examined the conjunctival fornix from unselected autopsies with no prior history of conjunctival or ocular disease for the presence of organized MALT. In only 31 per cent of cases was organized lymphoid tissue found with the morphological and immunophenotypic features of MALT. This finding suggests that MALT is not found in the normal human conjunctiva but is acquired during life in a proportion of apparently asymptomatic individuals.

Non-bullous congenital ichthyosiform erythroderma, with ocular albinism and Noonan syndrome.

A 21-year-old woman presented with non-bullous congenital ichthyosiform erythroderma; she was born a collodion baby. Associated features were ocular albinism, anterior segment dysgenesis of both eyes and Noonan syndrome. X-linked ichthyosis (steroid sulphatase deficiency) and X-linked ocular albinism have been mapped to the Xp22.3 region and cases have been reported with both conditions due to a partial short-arm deletion of the X chromosome. The ichthyosis and ocular albinism in the present case, however, are likely to be of the autosomal recessive type - a very rare association - and the combination with Noonan syndrome has not been reported previously.

White light interferometry in amblyopic children--a pilot study.

Interferometric acuity using the IRAS white light interferometer was compared with Snellen acuity in nine amblyopic children between the ages of five and nine years, and nine aged matched controls. All of the amblyopic eyes achieved better grating acuities than Snellen acuities. Fifty-seven per cent of the amblyopes with a best corrected Snellen acuity of 6/18 or less in their amblyopic eye, achieved grating acuities indistinguishable from normal. The hand held white light interferometer may have a role in the assessment of meridional amblyopia and in children with high astigmatic errors.

The interaction between hydrogel lenses and sodium fluorescein. Theoretical and practical considerations.

The interaction between sodium fluorescein dye and hydrophilic contact lenses was assessed quantitatively by spectrophotometry. Absorption of dye into he lens matrix was found to be proportional to the exposure time and also depends on the optical power and water content of the lens. 0.9% saline appeared preferable to oxidising agents as a rinsing solution in decontamination procedures. 3% hydrogen peroxide solution affects the nature of fluorescein such that it becomes colourless and also absorb less incident light, whilst still being retained within the lens. The implications of our findings for practical lens decontamination and theoretical fluorescein/polymer binder are discussed.

The sensitive period for anisometropic amblyopia.

Fifty-five children with pure anisometropic amblyopia presented consecutively between 1983 and 1986. Analysis of their records was undertaken with respect to the age at presentation, the initial visual acuity after spectacle correction, and the final acuity attained after treatment. The results show that the final vision achieved does not depend on the age at presentation. The implications of these findings are discussed and their relations to the sensitive period for the development of amblyopia from other causes outlined.

Microtropia versus bifoveal fixation in anisometropic amblyopia.

Microtropia with identity is a unique condition in which amblyopes have parafoveal eccentric fixation in the amblyopic eye in either monocular or binocular viewing, plus a macular scotoma. The condition has previously been described in anisometropic amblyopia. The records of 55 consecutively presenting anisometropic amblyopes were scrutinised and the cases divided into microtropes or non-microtropes (bifoveal fixators). The features of the two groups were then compared to identify factors associated with microtropia and to determine whether microtropes or bifoveal patients responded better to amblyopia therapy. Results show that 45% of anisometropic amblyopes have microtropia rather than bifoveal fixation. There appears to be no association between the microtropic phenomenon and age, depth of amblyopia or amount of anisometropia. Bifoveal patients may respond better to amblyopia therapy although the difference between groups was not great. The sensitive period during which amblyopia may be treated is the same for each group.

The use of the same size host and donor trephine in penetrating keratoplasty for keratoconus.

The results of a retrospective analysis of 49 eyes (40 patients) that underwent penetrating keratoplasty for keratoconus are presented. All grafts had the same size trephine for both host and donor corneas. Ninety-eight per cent of eyes achieved a post-operative visual acuity of 6/12 or better; 43% of eyes attained this level of acuity unaided, although more than half of these required spectacles or contact lenses to reach their best corrected acuity. The average post-operative spherical ametropia was -0.5 dioptre (SD 2.97 dioptres) and the average post-operative cylinder was -3.8 dioptres (SD 2.63 dioptres). Three eyes (6%) required keratorefractive surgery to reduce astigmatism. Wound integrity was satisfactory using the same (size) trephine for both host and donor, with no patient suffering a post-operative wound leak or iris prolapse. The reduction of post-operative myopia and astigmatism is discussed.

Determination of the nodal point position in the pseudophakic eye.

The optics of the schematic eye have been described by Gullstrand and Listing (System of Ophthalmology (ed. H. Kimpton), Vol. 5, C. V. Mosby, London (1970], data being averaged from a series of adult eyes with a crystalline lens. A ray of light from the height of any given object passing, undeviated, through the nodal point will determine the height of its image on the retina. The nodal point positions, therefore, are fundamental in determining image size, and any eye-to-eye variation in a patient will control the amount of aniseikonia. The optics of the pseudophakic eye are described together with a scientific method for determining the nodal point positions, and the implications are discussed.

Lacrimal fossa block: an audit of a minimally invasive regional anaesthetic technique for endoscopic dacryocystorhinostomy (DCR).

The lacrimal fossa block (LFB), a new development to provide regional anaesthesia for endoscopic dacryocystorhinostomy, is reported. Cadaveric study showed that the block needle, inserted as described, made direct contact with the periosteum of the frontal process of the maxilla within the lacrimal fossa. This technique enables both relevant divisions of the trigeminal nerve to be anaesthetized through a single entry site and, as this injection is confined to the anterior part of the orbit, ocular complications are minimized. An audit of 66 patients has shown that this technique, combined with standard intranasal local anaesthesia, provides good intraoperative analgesia, causes minimal diplopia and has a high level of patient acceptability.

Visual performance in idiopathic macular holes.

Previously published reports on the clinical features of idiopathic macular holes highlight the predilection for post-menopausal women and implicate vitreomacular traction in the aetiology of these lesions. Relatively little attention, however, has been paid to the quality of visual loss in eyes with macular holes. Histological studies of full-thickness macular holes have shown loss of all retinal layers in the area of the hole, and this would be expected to produce a central absolute scotoma of the same diameter. The majority of patients with full-thickness holes in this series did not have an absolute scotoma large enough to be detected on the Amsler Chart or when reading. It is suggested that following formation of a macular hole, enlargement may occur without further loss of foveal tissue and without enlargement of the absolute scotoma, due to tangential vitreous traction or contraction of an associated epiretinal membrane.