Intravitreal Methotrexate for Iris and Ciliary Body Relapse in Acute Lymphoblastic Leukemia.

The authors report a rare unilateral iris and ciliary body relapse in acute lymphoblastic leukemia. Ophthalmologic examination showed reduced visual acuity, pseudohypopyon, and iris irregularity. Ultrasound biomicroscopy and aqueous humor cytology confirmed leukemic infiltration. Lesions were treated with intravitreal methotrexate, which has not been described previously for acute lymphoblastic leukemia. [J Pediatr Ophthalmol Strabismus. 2018;55:e16-e19.].

Comparisons of choroidal nevus measurements obtained using 10- and 20-MHz ultrasound and spectral domain optical coherence tomography.

PURPOSE:: To compare measurements of lesions clinically diagnosed as choroidal nevi using spectral domain optical coherence tomography (SD-OCT) and 10- and 20-MHz ultrasound (US). METHODS:: This prospective study, which was conducted between May 2011 and December 2011, evaluated eyes diagnosed with choroidal nevus via photographic documentation using 10- or 20-MHz A- and B-mode US (experienced examiner using both the transpalpebral technique and direct contact) or SD-OCT in the enhanced depth imaging mode (performed by a different examiner blinded to the US results). Anteroposterior (AP) and transverse (T) US sections corresponded to sections adjusted perpendicularly on SD-OCT. RESULTS:: We evaluated 14 eyes from 12 patients (six males, mean patient age= 64.5 years) diagnosed with choroidal nevus. The choroidal nevi of all samples had a melanocytic profile. Moreover, eight nevi were located at the equator, five nevi were located in the posterior pole (peripapillary in one sample), and one nevus shifted from the equator to the periphery. On SD-OCT, the maximum measurable dimension was 9 mm. The lesions in the posterior pole were easier to evaluate, and image acquisition of lesions located more peripherally was possible depending on patient cooperation. The accurate assessment of height was difficult. Baseline dimensions on 10- and 20-MHz US were larger than those determined via OCT. No significant differences in height were observed between US and SD-OCT. All parameters were statistically similar between 10- and 20-MHz US measurements. CONCLUSIONS:: No significant difference in the AP and T diameters was observed between 10- and 20-MHz US measurements; however, these measurements (AP and T) were significantly higher than those obtained using OCT. No significant differences in height were observed among the techniques adopted.

Comparisons of choroidal nevus measurements obtained using 10- and 20-MHz ultrasound and spectral domain optical coherence tomography / Comparação entre a medida de nevus de coroide obtida com 10-MHz e 20-MHz e tomografia de coerência óptica de domínio espectral

ABSTRACT Purpose: To compare measurements of lesions clinically diagnosed as choroidal nevi using spectral domain optical coherence tomography (SD-OCT) and 10- and 20-MHz ultrasound (US). Methods: This prospective study, which was conducted between May 2011 and December 2011, evaluated eyes diagnosed with choroidal nevus via photographic documentation using 10- or 20-MHz A- and B-mode US (experienced examiner using both the transpalpebral technique and direct contact) or SD-OCT in the enhanced depth imaging mode (performed by a different examiner blinded to the US results). Anteroposterior (AP) and transverse (T) US sections corresponded to sections adjusted perpendicularly on SD-OCT. Results: We evaluated 14 eyes from 12 patients (six males, mean patient age= 64.5 years) diagnosed with choroidal nevus. The choroidal nevi of all samples had a melanocytic profile. Moreover, eight nevi were located at the equator, five nevi were located in the posterior pole (peripapillary in one sample), and one nevus shifted from the equator to the periphery. On SD-OCT, the maximum measurable dimension was 9 mm. The lesions in the posterior pole were easier to evaluate, and image acquisition of lesions located more peripherally was possible depending on patient cooperation. The accurate assessment of height was difficult. Baseline dimensions on 10- and 20-MHz US were larger than those determined via OCT. No significant differences in height were observed between US and SD-OCT. All parameters were statistically similar between 10- and 20-MHz US measurements. Conclusions: No significant difference in the AP and T diameters was observed between 10- and 20-MHz US measurements; however, these measurements (AP and T) were significantly higher than those obtained using OCT. No significant differences in height were observed among the techniques adopted.

RESUMO Objetivo: Comparar as medidas obtidas de lesões diagnosticadas clinicamente como nevus de coroide através da tomografia de coerência óptica de domínio espectral (Spectralis, Heidelberg Engineering, Inc.), ultrassonografia com 10 MHz e de 20 MHz. Métodos: Estudo prospectivo realizado entre maio e dezembro de 2011, avaliou olhos com diagnóstico de nevus de coroide, utilizando documentação fotográfica, ultrassonografia com transdutor 10-MHz e 20-MHz A- e B-mode e SD-OCT em modo de EDI, por um examinador diferente para cada técnica. Os cortes realizados perpendiculares entre si, correspondentes ao corte ântero-posterior e latero-lateral à ultrassonografia. Resultados: Foram avaliados 14 olhos de 12 pacientes (6 do sexo masculino), com média de idade média de 64,5 anos. Todos os nevus tinham um perfil melanocítico. Observou-se 8 nevus no equador, 5 no polo posterior (peripapilar em uma amostra), e 1 deslocado a partir do equador para a periferia. Em SD-OCT, a dimensão máxima mensurável foi de 9 mm. As lesões no polo posterior eram mais fáceis de avaliar e aquisição de imagens de lesões mais periféricas era possível, dependendo da colaboração do paciente. A avaliação precisa da altura era difícil. As dimensões usando transdutor 10-MHz e 20-MHz US foram maiores que as encontradas pelo SD-OCT. Não foram observadas diferenças significativas na altura entre métodos SD-OCT e US. Todas as medidas foram estatisticamente semelhantes entre 20-MHz e 10-MHz. Conclusão: Para o parâmetro AP e T não foi detectada diferença entre as medidas utilizando US de 10-MHz e de 20-MHz. Porém estas medidas se mostraram significativamente maiores em relação à medida obtida com OCT. Para a altura, não foram detectadas diferenças estatística em relação à técnica utilizada, US 10-MHz e 20-MHz e SD-OCT.

Resultados da associação trabeculotomia-trabeculectomia em pacientes não idosos / Results of trabeculotomy-trabeculectomy in not elderly patients

Objetivo: Avaliar os resultados da associação trabeculotomia-trabeculectomia (Tro-Trec) em pacientes de 12 a 50 anos, com glaucoma moderado ou avançado. Métodos: estudo prospectivo de 19 olhos de 13 pacientes, de 12 a 50 anos (média de 33,77 ± 11,43), submetidos à Tro-Trec e seguidos por 21,6 ± 7,2 (5,1 a 29,7) meses. Resultados: A pressão intraocular, (PIO) média inicial de 32,03 ± 10,01 mmHg (variando de 12 a 50), foi reduzida para 9,42 mmHg ± 3,50 (2 e 16), com redução da medicação tópica de 1,47 ± 1,54 (0 a 4) para 0,16 ± 0,37 (0 a 1) medicamentos. A PIO alvo foi atingida em 15 (78,94%) olhos. Houve acentuada redução da PIO mesmo em olhos sem bolhas significativas. O procedimento resultou em hipotonia persistente em três olhos. Conclusão: A cirurgia proposta foi eficaz. A acentuada redução da PIO em olhos sem bolhas significativas sugere que, na faixa etária analisada, a trabeculotomia isolada pode ser suficiente para controle da PIO em alguns pacientes. A incidência de hipotonia foi significativa, porém não superior à relacionada à trabeculectomia isolada, para a mesma faixa etária.

Purpose: To evaluate the results of the trabeculotomy-trabeculectomy combined procedure in 12 to 50 years old patients with moderate and advanced glaucoma. Methods: Nineteen eyes of thirteen patients underwent a trabeculotomy-trabeculectomy procedure and were prospectively analyzed and followed up for 21,6 ± 7,2 (5,1 a 29,7) months. Results: IOP was reduced from 32,03 ± 10,01 (12 to 50) mmHg to 9,42 ± 3,50 (2 e 16) mmHg with the number of topical medications being reduced from 1,47 ± 1,54 (0 a 4) to 0,16 ± 0,37 (0 a 1). The target IOP was obtained in 15 of the eyes (78,94%). A great IOP reduction was obtained in eyes without significant blebs. Three eyes developed persistent hipotony. Conclusion: The procedure proved to be effective. The IOP reduction in eyes without significant blebs make us to infer that isolated trabeculotomy should be sufficient to control IOP for some of these eyes. The occurency of hipotony was similar to that from isolated trabeculectomy for pacients of the same age.