Cryosurgery during Imiquimod (Immunocryosurgery) for Periocular Basal Cell Carcinomas: An Efficacious Minimally Invasive Treatment Alternative.

BACKGROUND/AIM: Periocular basal cell carcinomas (pBCC) remain a treatment challenge. Our aim was to retrospectively evaluate the feasibility and efficacy of immunocryosurgery for the treatment of pBCC. METHODS: Immunocryosurgery is given in 5-week cycles of daily imiquimod, with cryosurgery on day 14. Patients treated between 1/1/2008 and 31/12/2014 were included in this study. RESULTS: Immunocryosurgery was offered to 19 patients. Of these, 16 (i.e., 6 males and 10 females, average age 74.9 years, median tumor diameter 15 mm, range 5-60 mm), with 1 tumor each, were treated. Six tumors (37.5%) were relapses after surgery and 2 were of metatypical histology. All BCC were high risk for recurrence after treatment; 10 tumors had 2 risk factors for relapse, 5 had 3, and 1 had 4. The follow-up period ranged between 3 and 60 months (average 25.6 months). Of the 16 tumors treated, 14 (all with a diameter <40 mm) cleared with immunocryosurgery (total efficacy 87.5%); 7 out of 16 tumors (44%; all with a diameter ≤20 mm) cleared with 1 conventional 5-week immunocryosurgery treatment cycle. Seven additional tumors (including 2 with a diameter >20 mm) required intensified treatment schemes (of up to 10 weeks) for clearance. The 2 tumors that did not clear responded partially and were also the 2 largest ones (diameter 40 and 60 mm). Of the 14 cleared tumors, 2 relapsed during follow-up; 1 cleared with immunocryosurgery. At the last examination during follow-up, 13 out of 16 (81%) patients were in sustained clinical remission. CONCLUSIONS: For most pBCC, immunocryosurgery is a feasible and efficacious alternative to surgical excision.

Molecular Analysis of Dirofilaria repens Isolates from Eye-Care Patients in Greece.

PURPOSE: Human ocular dirofilariasis is a zoonotic disease caused by several species of filarioid helminths of the genus Dirofilaria. The aim of this study was to further re-examine five preserved specimens previously isolated from patients with ocular dirofilariasis by molecular means. METHODS: Four of the examined helminths had been stored in unbuffered formaldehyde solution for more than eight years; whereas, the fifth helminth was stored in ethanol buffer for more than two years. For the four specimens stored in formaldehyde, different methods of DNA recovery and amplification were applied and investigated for their efficiency in DNA extraction and PCR amplification. However, the DNA extraction and PCR amplification were successful only for the ethanol-preserved helminth. RESULTS: The genetic identification of the ethanol-preserved specimen as Dirofilaria repens (D. repens) and its phylogenetic position based on the analysis of mitochondrial 12S ribosomal RNA, nuclear 18S ribosomal RNA and mitochondrial cytochrome c oxidase subunit one sequences are reported in the present paper. To our knowledge, these are the only deposited sequences related to D. repens that have been isolated in Greece. CONCLUSIONS: Routine laboratory diagnosis is based on phenotypic characteristics of the helminthic parasites, but more accurate diagnosis requires molecular identification. Although the specimens preserved in formalin buffers may be a potential source for the enrichment of parasite genome databases, the DNA recovery of such samples is a challenging task.

Tear Film Osmolarity in Subjects with Acute Allergic Rhinoconjunctivitis.

BACKGROUND/AIM: Acute allergic rhinoconjuctivitis is the most common form of ocular allergies. The pathogenetic mechanisms are based on an immunoglobulin E (IgE)-mediated hypersensitivity reaction. On the other hand, tear osmolarity has been suggested to be an index of ocular surface damage and inflammation. These data were the motive to investigate the levels of tear osmolarity in subjects with acute allergic rhinoconjuctivitis, before and after administration of artificial tears. PATIENTS AND METHODS: Forty-five subjects with acute allergic rhinoconjuctivitis were randomly divided into three groups, based on the type of artificial tears that they received: Group A (Thera tears), Group B (Wet therapy) and Group C (Tears Naturale free). The eye drops were administered six times a day for 60 days and all subjects underwent grading of subjective symptoms and clinical examination at baseline and at the end of the treatment. RESULTS: The diagnosis of severe eye disease, which was based on ocular surface disease index (OSDI; Allergan, Inc, Irvine, CA, USA) and tear osmolarity values, concerned all patients at baseline. Although the administration of artificial tears significantly ameliorated the symptoms and the ocular variables in all groups, the results were better in the first group. Tear osmolarity was strongly and negatively correlated with tear film breakup time (BUT) and Schirmer I test at 2 months. Contrariwise, symptoms were eliminated, when tear osmolarity was decreased. CONCLUSION: Acute allergic rhinoconjuctivitis is characterized by tear hyperosmolarity, which can be rehabilitated with the administration of hypotonic artificial tears.

Eye and Periocular Skin Involvement in Herpes Zoster Infection.

Herpes zoster ophthalmicus (HZO) is a clinical manifestation of the reactivation of latent varicella zoster virus (VZV) infection and is more common in people with diminished cell-mediated immunity. Lesions and pain correspond to the affected dermatomes, mostly in first or second trigeminal branch and progress from maculae, papules to vesicles and form pustules, and crusts. Complications are cutaneous, visceral, neurological, ocular, but the most debilitating is post-herpetic neuralgia. Herpes zoster ophthalmicus may affect all the ophthalmic structures, but most severe eye-threatening complications are panuveitis, acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) as well. Antiviral medications remain the primary therapy, mainly useful in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of HZO are critical in limiting visual morbidity. Vaccine in adults over 60 was found to be highly effective to boost waning immunity what reduces both the burden of herpes zoster (HZ) disease and the incidence of post-herpetic neuralgia (PHN).

Ocular dirofilariasis: a case series of 8 patients.

PURPOSE: Dirofilaria repens is an endemic parasite in Mediterranean countries that mostly affects animals. Rarely, however, it can infect humans. This case series presents patients with ocular infections due to D. repens. MATERIALS AND METHODS: A chart review was performed of patients with ocular dirofilariasis after the year 2000, treated at a tertiary referral centre in Greece. Data were collected on the ocular, microbiological, or/and histopathological aspects and treatment. RESULTS: Eight cases of unilateral ocular dirofilariasis were identified, of which 5 were subconjunctival (1 masquerading as nodular scleritis) and were removed through a conjunctival incision, 2 cases were intravitreal and were removed with vitrectomy, and 1 was intraorbital (adjacent to the roof of the orbit). The latter appeared as an encapsulated mass and subsequent histological examination revealed the presence of the parasite. Of the 8 cases recorded after the year 2000, 7 appeared within the last 6 years (4 cases within the last 3 years). The majority of cases involved residents of the Ionian Islands (7 of 8 cases). CONCLUSIONS: D. repens can affect various ocular and periocular tissues. A progressive increase in the incidence of dirofilariasis was observed, which is potentially associated with climate changes in warm and moist areas where this parasite is endemic.

Contrast sensitivity and color vision in eyes with retinitis pigmentosa and good visual acuity: correlations with SD-OCT findings.

BACKGROUND AND OBJECTIVE: To investigate the morphological substrate of the changes in visual function in eyes with retinitis pigmentosa and good visual acuity using spectral-domain optical coherence tomography (SD-OCT). PATIENTS AND METHODS: A total of 30 eyes of 17 patients with retinitis pigmentosa and visual acuity of 20/40 or better underwent contrast sensitivity and color vision testing. The retinal thickness at the fovea and macula and the length of the photoreceptor inner/outer segment (IS/OS) junction were assessed by SD-OCT. Structural-functional correlations were investigated. RESULTS: Contrast sensitivity correlated well with IS/OS length (Spearman r = 0.719, P < .001) and foveal thickness (r = 0.672, P < .001) and moderately with macular thickness (r = 0.422, P = .025). Moreover, color vision correlated significantly with IS/OS length (r = -0.725, P < .001) and foveal thickness (r = -0.661, P < .001). CONCLUSION: In eyes with retinitis pigmentosa and good visual acuity, the structural changes observed on OCT scans correspond well to subtle measures of central visual function, complementary to visual acuity testing.