Transcleral orbital invasion by a radiation and chemotherapy-resistant choroidal metastasis of a pulmonary adenocarcinoma.

PURPOSE: To report transcleral orbital invasion by a radiation- and chemotherapy-resistant choroidal metastasis of a pulmonary adenocarcinoma. DESIGN: Interventional case report. METHODS: A 51-year-old female was found to have choroidal metastasis from a previously unknown primary pulmonary adenocarcinoma. She underwent external beam radiation treatment with a total dose of 40 Gray (Gy), delivered in 20 fractions over 28 days, followed by adjuvant chemotherapy with gemcitabine and carboplatin. After completing two of the three scheduled chemotherapy cycles, the choroidal lesion was observed to have increased in size. RESULTS: A transvitreal aspiration biopsy of the choroidal lesion confirmed the diagnosis of metastatic pulmonary adenocarcinoma. Enucleation was performed for intractable pain. Histopathology revealed invasion through scleral emissary channels to the retrobulbar tissue and through the optic nerve substance itself. CONCLUSIONS: Despite appropriate external beam radiation therapy (EBRT) and chemotherapy, pulmonary adenocarcinoma metastases to the choroid can continue to grow and may invade the orbit transclerally.

Rapid progression of amebic keratitis 1 week after corneal trauma and 1 year after LASIK.

PURPOSE: To report a case of amebic keratitis that showed unusually rapid clinical progression after corneal trauma in a patient 1 year after successful laser in situ keratomileusis (LASIK) surgery. METHODS: A 42-year-old pilot with a previous history of 20/20 uncorrected vision 1 year after LASIK surgery developed a clinical picture suggestive of acute microbial keratitis 7 days after the eye was traumatized by an ice chip. The correct diagnosis of amebic keratitis was confirmed by tissue biopsy 17 days after initial trauma when rapid progression of the keratitis necessitated excision of the LASIK flap. RESULTS: Pathology from the excised LASIK flap showed a mean of 30 amebic cysts per high power field. Thirty-three days after beginning 0.02% polyhexamethylene biguanide every hour, the patient developed culture negative hypopyon and an endothelial inflammatory plaque. Six months after starting antiamebic treatment, he developed sterile iris nodules and focal hemorrhages in the anterior chamber. Penetrating keratoplasty revealed persistence of amebic cysts in the anterior corneal stroma. Fifteen months after his initial injury, his vision remains hand motion. CONCLUSIONS: Amebic keratitis presented atypically and progressed rapidly to a stage of severe ring infiltrate within 10 days of trauma in a patient whose only risk factor was a history of uncomplicated LASIK more than 1 year before the trauma. Amebic keratitis should be included in the differential diagnosis of rapidly progressive corneal ulcer after trauma in patients with a history of LASIK.

Severe astigmatic amblyopia secondary to subcutaneous juvenile xanthogranuloma of the eyelid.

A number of eyelid lesions in early childhood, most commonly dacryoceles and hemangiomas, have been documented to cause astigmatic changes of the cornea. Juvenile xanthogranuloma (JXG) is typically reported to include both cutaneous skin and anterior ocular segment lesions. We report a case of a 10-month-old infant in which a subcutaneous JXG lesion of the lower eyelid resulted in visually significant astigmatic amblyopia.

The current status of diabetes care, diabetic retinopathy screening and eye-care in British Columbia's First Nations Communities.

OBJECTIVES: The objective of this study was to evaluate the current status of primary diabetes care, diabetic retinopathy screening, and eye-care for First Nations individuals with diabetes living on-reserve in British Columbia. STUDY DESIGN: Prospective cross-sectional observational survey. METHODS: A mail-out survey was sent to all BC First Nations Communities in the format of a 26-item questionnaire. A series of general questions were asked concerning community populations, regional transportation options and the availability of local health-care providers. Specific questions about the frequency and source of eye and diabetic retinopathy care in each community were also solicited. RESULTS: A sixty-seven percent questionnaire response rate was achieved (136/202 communities). The community-reported rate of diabetes mellitus ranged from 4.8 to 11.8% with an average of 6.4%. The proportion of on-reserve individuals with diabetes receiving yearly retinal examinations for diabetic retinopathy was found to be only 33%. Many communities received eye-care from more than one professional group, but the majority of basic eye-care and retinopathy screening was provided by optometrists. Ophthalmologists were less likely to provide eye care for these communities; however, family physicians and nurses were frequently responsible for performing eye evaluations. CONCLUSIONS: The vast majority of First Nations people with diabetes who live on-reserve in British Columbia do not have access to annual examinations by an eye-care professional. Eye evaluations and retinal screening were often the responsibility of individuals with little formal training in this area.

Technique for removal of a capsular tension ring from the vitreous.

PURPOSE: To report a new technique for safely and quickly removing a displaced capsular tension ring from the vitreous cavity. DESIGN: Two interventional case reports. PARTICIPANTS: The authors retrospectively reviewed the charts of two patients with displaced capsular tension rings (CTRs). INTERVENTION: Surgical removal of the displaced CTRs was performed in two patients. MAIN OUTCOME MEASURES: Visual and anatomic outcomes. RESULTS: The CTRs were removed surgically, in case 1 by cutting the CTR into two pieces before removal and in case 2 by using the CTR injector to remove the CTR in one piece through a sclerotomy site. Both patients had good visual and anatomic outcomes. CONCLUSIONS: The described technique of removing a displaced CTR in one piece through a sclerotomy site using the CTR injector provides a safe and efficient method of CTR removal. Cutting the CTR into two or more pieces for removal is not recommended.