Imiquimod 5% cream as an adjuvant pre-operative treatment for basal cell carcinoma of the periocular area.

Despite national guidelines in the UK, patients with low-grade periocular malignancies frequently wait a period of months for their surgery. We have devised a protocol of pre-treatment with an immune modulator in an attempt to reduce the tumour size whilst patients await surgery. We present a case series of 5 patients who used Imiquimod 5% cream (Aldara) for 4 weeks as an adjuvant treatment prior to the excision of periocular nodular basal cell carcinomas. We also assessed tolerability of the cream using a visual analogue scale and recorded adverse events. Our patients had an average 22% reduction in tumour area (range 3.31%-39.64%) whilst awaiting surgery. The medication had a good tolerability profile and there were no ocular adverse events. Due to the promising results, this pilot study demonstrates the feasibility and value of a planned multicentre, prospective research project to further explore these initial findings.

Rate of posterior capsule opacification in eyes with the Akreos intraocular lens.

PURPOSE: To determine the rate of posterior capsule opacification (PCO) in eyes with an Akreos Adapt or Akreos Fit intraocular lens (IOL) (Bausch & Lomb) over a minimum follow-up of 18 months. SETTING: Department of Ophthalmology, Worthing and Southlands Hospital NHS Trust, Worthing, United Kingdom. METHOD: This was a retrospective analysis of 102 patients who had uneventful phacoemulsification with implantation of an Akreos Adapt IOL or Akreos Fit IOL from September 2001 to May 2004. Patients from a single surgeon's operating list were recruited into the study. Exclusion criteria included posterior subcapsular cataract, history of uveitis, diabetic retinopathy, glaucoma, and age-related macular degeneration. The protocol included the determination of logMAR best corrected visual acuity (BCVA) and PCO scoring using the Evaluation of Posterior Capsular Opacification System (EPCO 2000) by digital photography of the posterior capsule. The number of patients having a neodymium:YAG (Nd:YAG) capsulotomy was also recorded. RESULTS: The mean follow-up was 30 months +/- 10.3 (SD). The mean BCVA was 20/32 (0.2 logMAR). The mean EPCO score at the central 6.0 mm of the posterior capsule was 0.39 +/- 0.53 and at the central 3.0 mm, 0.18 +/- 0.40. The Nd:YAG capsulotomy rate was 8.8%. CONCLUSIONS: All patients had stable visual acuity with low rates of PCO 2.5 years after surgery. The PCO rate with the Akreos IOL was similar to that with other acrylic IOLs reported in the literature.

Outcome of periocular basal cell carcinoma managed by overnight paraffin section.

BACKGROUND: Surgical excision of periocular skin cancer allows for optimum control in terms of tumour recurrence. Although Mohs' technique gives the best outcome, it is not widely available. Processing paraffin sections is slower but histologically superior to Mohs' frozen sections. We report the results of using a standard paraffin section (non-Mohs') technique to confirm histological clearance. METHOD: A retrospective study between 1/6/95 and 1/6/99 of all consecutive patients who had excision of periocular cancer was performed. All patients had surgical excision of the tumour with a 3-mm margin. Rapid (24-hour) paraffin sections were done and reconstruction performed if histological clearance was confirmed. If tumour was still present, a further 3-mm margin was excised at the appropriate edge(s) before reconstruction took place. RESULTS: This study yielded 93 basal cell carcinomas (BCCs) of which 86 were of primary origin and 7 were recurrent tumours. The tumour characteristics were as follows: 88% nodular BCCs, 82% had a maximum surface measurement less than or equal to 10 mm, 39.8% were inner canthal and 49.5% were localised to the lower lid. In the 30 (35.4%) cases that required further excision based on the initial histological reports, tumour was seen in only four (11.4%) cases. Overall histological clearance for primary BCCs was achieved in 81/86 (94.2%) cases. There was only one late recurrence at 4 years and 5 months. Among recurrent BCCs, there was one recurrence (12.5%) and this was despite histological clearance having been reported. CONCLUSION: For primary BCCs the recurrence rate in this study was low and comparable to that following Mohs' technique. This approach, using routine pathological facilities, therefore offers a viable technique for managing periocular BCCs.