Primary photodynamic therapy with verteporfin for small pigmented posterior pole choroidal melanoma.

PurposeThe purpose of the study was to investigate the outcomes of primary photodynamic therapy (PDT) for small pigmented posterior pole choroidal melanoma.Patients and methodsProspective interventional consecutive case series of 15 patients with small pigmented posterior pole choroidal melanoma, who were treated with three sessions of PDT and followed-up thereafter. Risk factors for failure were assessed and outcome measures at presentation were compared to those at last follow-up visit.ResultsTumor control was achieved in 12 (80%) patients in a median follow-up time of 15 months (mean 14, range 8-18). Three patients failed treatment, diagnosed in a median time of 5 months (mean 4, range 3-6), after first PDT. In all failed cases, lesions were 100% pigmented; de novo melanoma rather than transformed nevi and showed a radial growth pattern rather than increased thickness. All failed cases were subsequently successfully treated with radiotherapy. In this cohort, subretinal fluid (SRF) was significantly reduced (P<0.001), vision did not deteriorate (P=0.11) and even improved in patients with subfoveal SRF at presentation (P=0.018), tumor height significantly decreased (P=0.037) and no complications were recorded.ConclusionPrimary PDT was found to be a safe and efficient treatment modality for small pigmented posterior pole choroidal melanoma, achieving short-term tumor control in 80% of patients. PDT offers patients the opportunity to preserve vision by avoiding the retinopathy associated with conventional radiation treatments for choroidal melanoma. However, the long-term local control of these tumors remains uncertain.

Intravitreal bevacizumab monotherapy for choroidal neovascularisation secondary to choroidal osteoma.

PurposeThe purpose of this study is to present the outcomes of a series of patients with choroidal neovascular membrane (choroidal neovascularisation (CNV)) secondary to a choroidal osteoma undergoing anti-VEGF monotherapy.Patients and methodsRetrospective series of patients with choroidal neovascularization secondary to choroidal osteoma. All patients underwent clinical and imaging assessment (fundus photo, B-scan ultrasonography, fluorescein angiography, and optical coherence tomography-where available), and were managed with intravitreal anti-VEGF injections (Bevacizumab). Visual acuity and central retinal thickness were recorded pre treatment and at the end of the follow-up period.ResultsEight patients were included in this study. Of this, 6/8 had predominantly classic or classic and 2/8 patients had minimally classic or occult CNV. Each patient received 3-10 injections of bevacizumab. Median follow-up was 9 months (3-15 months). Visual acuity improved in 5 patients, by 2-6 Snellen lines. CNV completely regressed in 5 cases and partially regressed in 3 cases. Mean CRT reduction was 122 µm (6 to -230 µm).ConclusionIntravitreal bevacizumab can be an effective treatment modality in the management of vision threatening CNV secondary to choroidal osteoma.

Lepromatous leprosy: An Unusual Presentation.

A 25 year old man presented with loss of sensations over both hands and feet and extreme difficulty in passing urine. On examination, an indurated sclerotic plaque was present on shaft of penis and scrotum in addition to other features of lepromatous leprosy. Skin biopsy from the penile lesion showed presence of a large number of acid fast bacilli with a BI of 6+ extending into the epidermis and histopathology showed absence of Grenz zone and presence of foamy macrophages in the dermis up to the dermo-epidermal junction.

Choroidal metastasis from follicular cell thyroid carcinoma masquerading as circumscribed choroidal haemangioma.

Choroidal metastases from follicular thyroid carcinoma are uncommon and usually present as an amelanotic lesion against a background of known systemic disease. We present the case of a 56-year-old woman with a thyroid metastatic focus with unusual clinical presentation, systemic involvement, and early response to systemic treatment. A review of the literature accompanies this case presentation.

Decreasing strabismus surgery.

AIM: To determine whether there has been a consistent change across countries and healthcare systems in the frequency of strabismus surgery in children over the past decade. METHODS: Retrospective analysis of data on all strabismus surgery performed in NHS hospitals in England and Wales, on children aged 0-16 years between 1989 and 2000, and between 1994 and 2000 in Ontario (Canada) hospitals. These were compared with published data for Scotland, 1989-2000. RESULTS: Between 1989 and 1999-2000 the number of strabismus procedures performed on children, 0-16 years, in England decreased by 41.2% from 15 083 to 8869. Combined medial rectus recession with lateral rectus resection decreased from 5538 to 3013 (45.6%) in the same period. Bimedial recessions increased from 489 to 762, oblique tenotomies from 43 to 121, and the use of adjustable sutures from 29 to 44, in 2000. In Ontario, operations for squint decreased from 2280 to 1685 (26.1%) among 0-16 year olds between 1994 and 2000. CONCLUSION: The clinical impression of decrease in the frequency of paediatric strabismus surgery is confirmed. In the authors' opinion this cannot be fully explained by a decrease in births or by the method of healthcare funding. Two factors that might have contributed are better conservative strabismus management and increased subspecialisation that has improved the quality of surgery and the need for re-operation. This finding has a significant impact upon surgical services and also on the training of ophthalmologists.

Raman scattering investigations of nanocrystalline thorium oxide.

Raman scattering investigations are carried out on nanocrystalline thorium oxide powders. Shift and broadening of the Raman peak associated with F2g phonons are observed for the nanocrystalline samples as compared with those of the bulk. The peak shift and broadening are found to increase further as the particle size decreases. A quantitative analysis of the Raman line shape is carried out with a Gaussian confinement model, and the estimated size is found to be consistent with that obtained from X-ray diffraction and transmission electron microscopy.

Investigation of children with chronic diarrhoea.

OBJECTIVE: To study the lower G.I. endoscopic and histopathological findings in children with chronic diarrhoea. DESIGN: Prospective analysis. SETTING: Hospital based. SUBJECT: 83 children with age up to 14 years admitted in Umaid Hospital, Jodhpur including 33 subjects with chronic diarrhoea and 50 normal children in control group. METHODS: All 83 children including study (33) and control group (50) underwent lower G.I. Endoscopy using FUJINON-SIG-ET sigmoidoscope in older children and PENTAX FG-23H gastroscope in younger children after proper preparation. Rectal biopsies were taken in all the subjects except one and was sent for histopathological examination. RESULTS: Majority (90.8%) were in 0-5 year age group with median age of 3.8 years. We could finally reach to definitive diagnosis in 13% patients with chronic diarrhoea. Over all, colitis was the most common cause. CONCLUSION: Both, endoscopy and biopsy are needed to reach final diagnosis.

Identification and characterization of the tyrosine protein kinases of rat spleen.

High levels of tyrosine protein kinase have been recently detected in the membranes of rat spleen. In the present report the tyrosine protein kinase activity of the 30,000 x g pellet of rat spleen has been solubilized and partially purified by ion exchange and gel permeation chromatography. Two peaks of tyrosine protein kinase of Mr 35,000 (TPK-I) and Mr 40,000 (TPK-II) have been resolved. These kinases were free of the EGF receptor and insulin receptor tyrosine protein kinases. Although TPK-I and TPK-II phosphorylated angiotensin II, casein, histone, tubulin, phosphorylase b, and p36 they differed from each other in preference for the substrates. Both tyrosine protein kinases did not phosphorylate anti-pp60v-src IgG.