Possible role of standardized echography complementing ultrasound biomicroscopy in tumors of the anterior eye segment: a study in a series of 13 patients.

PURPOSE: To evaluate the efficacy of standardized A-scan echography (ASE) complementing ultrasound biomicroscopy (UBM) to propose the most efficient method as grounds for the diagnosis, treatment, and follow-up of anterior eye-segment tumors. METHODS: The inclusion criteria were tumors of the ciliary body and peripheral choroidal tumors, whose anterior border could not be visualized with a 10 MHz ultrasound probe. The largest basal dimension and the highest prominence of the tumor were measured with a UBM Lin 50 probe. A standardized A-scan examination determined the tumor's thickness and internal reflectivity. Thus, tissue differentiation led to a standardized echography-based diagnosis (SED). RESULTS: The study included 13 patients. SED was achieved in all examined tumors. The smallest thickness of the tumor of the ciliary body enabling SED was only 1.78 mm. The highest prominence of the tumor (3.66 ± 1.39 mm) was generally larger than its thickness (3.30 ± 1.71 mm). CONCLUSION: When approaching ciliary body tumors, both ASE and UBM should be performed, the former to accurately differentiate the tumor and measure its height, and the latter to delineate anterior tumor margins and iris involvement. Standardized echography-based diagnosis was grounds for further evaluation and/or treatment in this case series. The highest prominence of the ciliary body tumor perpendicular to the sclera as evidenced by UBM was generally higher than the thickness obtained with standardized echography. Hence, we propose ASE thickness to be the grounds for staging the severity of ciliary body tumors in the algorithm for their management.

Scleral Thinning Documented by Ultrasound Biomicroscopy after Plaque Therapy for Anterior Ciliary Melanoma.

PURPOSE: To evaluate, by ultrasound biomicroscopy (UBM), changes in scleral thickness after ruthenium-106 CCB and CCC plaque (Eckert & Ziegler BE-BIG GmbH, Berlin, Germany) therapy for anterior ciliary melanoma. METHODS: Eleven patients with anterior ciliary melanoma underwent ruthenium-106 CCB and CCC plaque radiation with a radiation dose at the tumor apex of 80-100 Gy. UBM measurements performed prior to and after treatment were as follows: the largest prominence of the tumor perpendicular to the sclera and scleral thickness at scleral spur, 1.0 mm, and 2.0 mm posteriorly. RESULTS: The article presents one year follow-up results for each of the 11 patients. The mean regression of the tumor of 24.3±9.31% was observed. The thinning of the sclera was statistically significant at the scleral spur (t=1.80, p ≤ 0.05) and at maximal tumor thickness (t=1.35, P=0.05). CONCLUSION: UBM documented significant thinning of the sclera at the scleral spur and overlying the maximal tumor thickness after Ru-106 CCB and CCC plaque radiation. Taking into consideration the shortcomings of the study-small sample size, insufficient probe resolution, and subjectively determined anatomic landmarks-observed minimal thickness change of the sclera does not necessarily mean its necrosis. However, thinning of the sclera documented at one year follow-up associated with very slow regression of the tumor indicates the need for the introduction of the CIA plaque treatment in our patients with anterior ciliary melanoma.

Timing of cataract surgery in diabetics.

In their retrospective study, the authors investigated the outcome of extracapsular cataract extraction (ECCE) followed by posterior chamber intraocular lens implantation (PCIOL), in 2864 operated eyes, out of which 546 (19%) were in diabetics. The preoperative retinal status was recorded in all subjects. In 6 (1%) patients, laser photocoagulation was performed preoperatively. The obtained visual acuity was 0.4 or better in 90.0% of diabetics and in 91.8% of control subjects, showing no significant difference in the postoperative complications between diabetics and non-diabetics. The results indicated the cataract operation (ECCE + PCIOL) to be a well tolerated surgical procedure in diabetic patients with lenticular opacity, in whom it should be even earlier performed than in nondiabetics, because cataract prevents the diagnosis or treatment of a suspect retinal disorder.

Triple procedure 'a chaud'.

Although it is widely accepted that acute uveitis is the main contraindication for intrabulbar procedures, conditions in the presented group of 24 patients (mean age 63 years, ranging from 35 to 74) required immediate surgery. The corneal pathologies included: perforated corneal ulcer in 12, imminent corneal perforation in ten and corneal melting syndrome in two patients. Partial perforative keratoplasty was accompanied by various combinations of surgical procedures, depending on the preoperative status. In cases of aphakia (N = 5) and anterior chamber pseudophakia (N = 5) secondary PCIOL implantation with sulcus fixation was performed, combined with ACIOL explanation in the latter group. The largest group included patients with complicated cataract (N = 14), where classic triple procedure was performed in ten patients. In three patients, the surgery had to be completed with sulcus fixation of the PCIOL, due to posterior capsule rupture. Associated glaucoma in one patient required trabeculectomy along with triple procedure. Postoperative complications that could not be treated with conservative measures for subsequent corneal decompensation, required rekeratoplasty in three (12.5%) patients. Visual acuity amelioration, ranging from 0.2-0.8, was achieved in seven (29.2%) and nine (37.5%) patients after 3 and 6 months, respectively.

Risks of retrobulbar application of anesthetics and drugs.

In spite of hundreds of harmless retrobulbar applications of anesthetics and drugs, a certain risk still exists. In the past ten years in our Department with 7200 retrobulbar procedures performed in local anesthesia and 12500 retrobulbar applications of the drugs (corticosteroids, antibiotics, vasodilatators) 14 incidents were registered. Palpebral chemosis and retrobulbar hematoma or eyeball protrusion were transient in 11 patients. Acute disturbance of the chorioretinal circulation occurred in three patients. In one of them vascular occlusion was total with permanent loss of vision, while in the other two recuperation of vision was the sign that vascular spasm was transient.