Quality of life and control of allergic rhinitis in patients from regions beyond western Europe and the United States.

There is comparatively little information on health-related quality of life (HRQoL) in subjects with allergic rhinitis (AR) or allergic rhinoconjunctivitis (AR/C) in countries beyond western Europe and North America. The primary aim of this investigation was therefore to review and assess the information in the public domain on HRQoL in AR/C patients from diverse regions of the world, represented by different countries, including Argentina, Australia, Brazil, Russia, Singapore, South Africa and Turkey. Second, in view of the absence of a standardized definition for 'AR control', the review aimed to determine whether a working definition of AR/C can be inferred from validated tests or other instruments documented to date. Despite the comparatively low number of studies, this review demonstrated that overall the symptoms of AR/C impair the HRQoL of patients in these regions by adversely impacting sleep, daily activities, physical and mental status and social functioning, similar to that demonstrated in much larger numbers of studies of AR/C patients in Europe and the United States. Furthermore, the findings of the review suggest that 'overall' control of the disease should encompass reduction of nasal and ocular symptoms, as well as improvements in HRQoL, comorbid conditions and cognition. Although some instruments are currently available for measuring control of AR, none are capable of assessing all these aspects, emphasizing the need to develop appropriate new instruments.

Observations on seven cases of intraocular leiomyoma. The 1993 Byron Demorest Lecture.

A review of seven cases of intraocular leiomyoma personally managed by the authors disclosed clinical and histopathologic characteristics that serve to differentiate this uncommon tumor from uveal melanoma. Leiomyoma generally occurs in younger patients and has a definite predilection for females. It tends to affect the ciliary body and peripheral choroid rather than the posterior choroid. In contrast to melanoma, which is located in the uveal stroma, leiomyoma usually is located in the supraciliary or suprachoroidal space. During transillumination, leiomyoma usually transmits light readily, whereas most melanomas cast a shadow. If intraocular leiomyoma is suspected clinically, the best management seems to be removal by a modified lamellar sclerouvectomy. In contrast to melanoma, leiomyoma shows positive immunoreactivity for muscle markers and negative immunoreactivity for melanoma-specific antigen and neural markers.

The role of fat-suppression technique and gadopentetate dimeglumine in magnetic resonance imaging evaluation of intraocular tumors and simulating lesions.

OBJECTIVE: Recent studies have shown that contrast (gadopentetate dimeglumine)-enhanced magnetic resonance imaging is useful in evaluating intraocular tumors and differentiating uveal melanoma from other simulating lesions. The purpose of this study was to study prospectively the role of fat-suppression technique and gadopentetate dimeglumine-enhanced magnetic resonance imaging in the evaluation of intraocular neoplasia. PATIENTS: Forty-three uveal melanomas and 20 other simulating intraocular lesions from 63 patients were prospectively evaluated on non-contrast-enhanced and post-contrast-enhanced T1-weighted images with and without fat-suppression technique and on T2-weighted images. RESULTS: Forty-one uveal melanomas (95%) were detected with standard pulse sequences and showed the characteristic hyperintense signal on non-contrast-enhanced T1-weighted images and hypointense signal with respect to the vitreous on T2-weighted images. All 33 uveal melanomas evaluated on non-contrast-enhanced T1-weighted images with fat-suppression technique were detected on non-contrast-enhanced images with fat-suppression technique. The intensity of the signal was statistically associated with the degree of pigmentation of the tumor on T1-weighted images with fat-suppression technique (P = .03). On post-contrast-enhanced T1-weighted images with or without fat-suppression technique, the 43 uveal melanomas showed enhancement. The degree of tumor enhancement was not statistically related to the degree of tumor pigmentation or the location of the tumor. Among the other simulating intraocular lesions, choroidal metastasis, retinoblastoma, choroidal leiomyoma, and medulloepithelioma demonstrated the same features on magnetic resonance imaging studies as uveal melanoma demonstrated on non-contrast-enhanced and post-contrast-enhanced T1-weighted images with or without fat-suppression technique. In our series, choroidal hemangioma, choroidal osteoma, posterior scleritis, retinal hemangioma, and Coats' disease can be differentiated from other amelanotic intraocular tumors by their characteristics on magnetic resonance imaging studies. CONCLUSIONS: We concluded that pre-and post-contrast-enhanced T1-weighted images with fat-suppression technique are most helpful in detecting small intraocular tumors with a thickness of more than 1.8 mm and in evaluating intraocular neoplasms and simulating lesions, particularly when T2-weighted images are not available. Moreover, in juxtapapillary choroidal or retinal tumor, fat-suppression technique may help in the detection of possible optic nerve or orbital extension by improving the conspicuousness of the tumor.

Use of the hydroxyapatite ocular implant in the pediatric population.

OBJECTIVES: There is always a hesitancy to use an ocular implant after enucleation in children, especially in cases of eyes enucleated for retinoblastoma. DESIGN AND SETTING: In this prospective study, we report our experience of 60 consecutive cases in which we used the hydroxyapatite ocular implant after enucleation in children younger than age 10 years. RESULTS: The mean age at the time of enucleation and hydroxyapatite placement was 27 months (range, 1 to 108 months). The histopathologic diagnoses after enucleation included retinoblastoma in 51 patients, endophthalmitis in two patients, persistent hyperplastic primary vitreous in two patients, neovascular glaucoma resulting from Coats' disease in one patient, uveal melanoma in two patients, undifferentiated intraocular neoplasm in one patient, and blind painful traumatized eye in one patient. After a mean follow-up of 19 months (range, 6 to 36 months), two cases of conjunctival erosion and five cases of conjunctival thinning were recorded. These problems were associated with a flat posterior prosthesis vault in all seven cases. There were no cases of orbital cellulitis, implant extrusion, or implant migration. All children showed good small-degree prosthesis motility despite the lack of peg placement. Only one older child underwent drilling and peg placement and she had excellent small- and large-degree prosthesis motility. We generally postpone the drilling and peg placement stage and tedious prosthesis revision in children until they are able to fully cooperate with the ocularist. CONCLUSIONS: The hydroxyapatite ocular implant is well tolerated and provides good prosthesis motility in children with few complications. It is critical for the ocularist to fit the prosthesis comfortably with a high posterior vault.

Primitive neuroectodermal tumor of the orbit.

A 10-year-old girl developed a lump in the lateral aspect of the right eyebrow over a 3-week period. Computed tomography and magnetic resonance imaging revealed a soft-tissue mass in the superolateral aspect of the right orbit associated with zygo-maticofrontal bone erosion and hyperostosis. An incisional biopsy specimen was studied using light microscopy, immunohistochemical staining, and electron microscopy, resulting in a diagnosis of peripheral primitive neuroectodermal tumor. The results of an extensive evaluation for systemic involvement were negative. The patient was subsequently treated with chemotherapy and radiation therapy. Primary primitive neuroectodermal tumor of the orbit is rare. The differential diagnosis and the diagnostic features of this entity are discussed herein.

Clinical predictive factors for development of recurrence and metastasis in conjunctival melanoma: a review of 68 cases.

Sixty eight cases of histologically proved conjunctival melanoma were reviewed in order to determine the clinical factors that were predictive of local recurrence and distant metastasis. All patients were treated with surgical excision and most had supplemental cryotherapy. The mean follow up was 7.5 years. Histopathologically, the conjunctival melanoma arose from primary acquired melanosis in 56%, from naevus in 26%, and de novo in 18%. Of the 68 patients, 38 (56%) developed at least one local tumour recurrence and 22 (32%) developed more than one recurrence. The method of initial treatment and the eventual development of metastasis were the two parameters statistically associated with tumour recurrence. Those patients treated initially with tumour excision alone had a statistically significant higher recurrence rate than those treated initially with excision and supplemental cryotherapy (p = 0.001). Fourteen patients (21%) developed metastasis and the mean period between treatment and metastasis was 3.6 years. Twelve (18%) died from metastatic melanoma with a mean interval of 4.4 years from the time of initial surgery until death. The only clinical parameter that was statistically associated with distant metastasis was local tumour recurrence (p = 0.015). Based on these observations, the authors make recommendations regarding the treatment of conjunctival malignant melanoma. It appears that initial complete excision of the tumour with supplemental cryotherapy offers the patient the best chance of remaining free of recurrence and metastasis.