Ocular Pentastomiasis in Human Hosts.

This case report describes the pathogenesis of ocular pentastomiasis in human hosts.

Six-year outcomes in neovascular age-related macular degeneration with ranibizumab.

AIM: To evaluate the outcomes of ≥6y ranibizumab therapy in neovascular age-related macular degeneration (AMD). METHODS: HELIX was a retrospective, observational effectiveness study using medical records of patients treated in three clinics in Belgium. Patients had neovascular AMD and were initially treated with intravitreal ranibizumab (0.5 mg) between November 1, 2007 and October 31, 2008, had ≥6y of data available, and were treated on an ongoing, as-needed basis. Outcomes included best-corrected visual acuity (BCVA) and central retinal thickness (CRT). RESULTS: The sample consisted of 88 eyes from 69 patients. Mean age was 76.4±6.5y, most patients were female (62.3%). Most eyes (62.5%) were treatment-naive, 33 previously treated eyes had received predominantly other anti-vascular endothelial growth factor agents and verteporfin. Mean baseline BCVA was 57.4±12.7 ETDRS letters and CRT was 291.5±86.1 µm. On average, patients received 20.6±11.9 ranibizumab injections over the ≥6y. Intervals between injections were on average 12.7±16.1wk. Mean change in BCVA from baseline to last observation for the sample was less than one letter (-0.9±17.3 letters), with an average loss of -3.2±15.6 letters in previously treated eyes versus a gain of 0.6±18.4 letters in treatment-naïve eyes. When considering a loss of <15 letters over 6y as stabilization of disease, 75.9% of all eyes showed a positive (improvement or stabilization) outcome. Mean change in CRT from baseline to last observation for the sample was -26.9±148.4 µm with the greatest reduction observed in treatment-naive eyes. CONCLUSION: This retrospective study of 69 neovascular AMD patients treated for ≥6y with ranibizumab demonstrates long-term visual stabilization. In light of the natural evolution of the disease, these data confirm that ranibizumab is effective long-term under real-world conditions of heterogeneity of patients, clinicians, and centers.

Visual acuity and factors influencing automobile driving status in 1,000 patients age 60 and older.

BACKGROUND: The objective of this prospective observational study was to evaluate the number of people driving in accordance with common legal standards, measured through far binocular visual acuity, and to identify variables associated with driving habits outside of legal standards. METHODS: Subjects aged 60 years and older were recruited at a tertiary referral center (University Hospital of Mont-Godinne, Yvoir, Belgium). Ophthalmological examination was conducted in all subjects by an ophthalmologist. Visual acuity was measured with the modified Early Treatment Diabetic Retinopathy charts at a distance of 4 m on each eye for far binocular visual acuity, defined as equal or better than 20/40, according to the European legal driving requirements. Details on demographic, socioeconomic, and medical characteristics were obtained from all participants by questionnaires. Numerical variables were compared with the Wilcoxon rank sum test. Categorical and ordinal parameters were compared with the Chi-square test or the Cochran test respectively. RESULTS: One thousand subjects (447 women and 553 men) were enrolled in the study over a period of 7 months (mean age: 71.3 ± 8.8 years), of whom 810 were current drivers. Among the 810 current drivers, 732 (90.4 %) had a far binocular visual acuity equal or better than 20/40 (mean 0.89), and 78 (9.6 %) did not (mean 0.36). Among the 190 non-drivers, 94 (49.5 %) never drove; 47 (24.7 %) had stopped driving because of their impaired vision; and 49 (25.8 %) had stopped driving for other reasons. A logistic regression was performed to identify the variables statistically associated with the practice of driving among licensed drivers without minimal visual requirements, which revealed that a non-recent ophthalmological examination (p < 0.001), the subject's non-perception of impaired vision (p = 0.001), and non-access to stores without a car (p < 0.001) were influencing factors. CONCLUSIONS: In our study, 81 % of subjects aged 60 years and older were still driving, of whom 10 % did not meet the European legal driving requirements set at equal or better than 20/40. The variables associated with driving status were the time of last examination, non-perception of a visual impairment, and limited access to stores without a car.

Conjunctival nevi clinical features and therapeutic outcomes.

OBJECTIVE: To determine the epidemiology and the clinical and therapeutic outcomes of conjunctival nevi and to identify the clinical variables statistically associated with operative excision. DESIGN: Prospective, observational, noncomparative case series. PARTICIPANTS: Two hundred fifty-five patients with the clinical diagnosis of conjunctival nevus. METHODS: Consecutive cases of conjunctival nevi managed at a single institution were studied to identify the clinical risk factors for operative excision. MAIN OUTCOME MEASURES: Reasons for operative excision. RESULTS: Of the 255 patients who were periodically observed for a mean of 5.3 years (range, 1-11), nevi were clinically diagnosed in 140 females and 115 males and modified operative excision was performed in 75 patients (29%). The decision of operative excision was made by the surgeon in 13 cases (17%) and by the patient in 62 cases (83%). In those 13 patients, the operative decision was prompted by our concern for possible malignant transformation based on suspicious biomicroscopic features in 10 patients (13%) and photographically documented tumor growth in 3 patients (4%). For the other 62 patients who elected to undergo surgery, their reasons for excision included patient's concern for cancer in 34 cases (45%), cosmetic arguments in 9 cases (12%), and patient's request owing to lesion-induced ocular surface irritation in 19 cases (25%). Comparison between groups showed that the clinical factors at initial visit that were statistically predictive of surgical excision were the older age of the patient (P = 0.001), the largest basal tumor diameter (P<0.001), tumor location (P = 0.023), and presence of clear cysts (P = 0.013), of intrinsic vasculature (P<0.001), of prominent feeder vessels (P<0.001), and of corneal involvement (P = 0.008). None of the excised lesions showed histopathologically malignant features. CONCLUSIONS: In our series, documented tumor growth of conjunctival nevus remained relatively a uncommon event with a incidence of 4%. Conjunctival nevi in older patients, associated with dilated feeder vessels, prominent intrinsic vasculature, and corneal involvement were more likely to be treated with operative excision. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

Choroidal metastasis from carcinoma of the bladder.

PURPOSE: To report choroidal metastasis from the newly described nested variant of urothelial carcinoma of the bladder as the initial presentation of metastatic disease. METHODS: A 58-year-old man with a history of urothelial bladder carcinoma developed progressive decreased visual acuity in the right eye. Fundus examination showed an amelanotic choroidal tumor simulating a choroidal melanoma. Results of ancillary diagnostic tests, needle aspiration biopsy, and systemic workup failed to confirm the diagnosis of choroidal metastasis. The patient was treated with enucleation the affected right eye. RESULTS: Histopathologic analysis of the enucleated eye disclosed a choroidal metastatic carcinoma with urothelial features similar to those of the bladder carcinoma excised previously. Despite adjuvant systemic chemotherapy, the patient died 7 months after enucleation. CONCLUSION: Choroidal metastasis may be the initial manifestation of metastatic bladder carcinoma and is associated with a poor survival prognosis.

Atypical spherical deposition on vitreoretinal interface associated with toxoplasmic chorioretinitis.

PURPOSE: To report the clinical and optical coherence tomography features of spherical deposits associated with recurrent toxoplasmic chorioretinitis. METHODS: Case report. RESULTS: Atypical, 100 microm to 150 microm, greyish deposits appeared along retinal arteries and veins as well as on the vitreoretinal interface in the macula of a 44-year-old Caucasian woman while she was being treated for recurrent toxoplasmic chorioretinitis with antiparasitic drugs and subconjunctival injection of betamethasone. They disappeared progressively with the systemic use of corticosteroids. Their clinical course was nicely documented by optical coherence tomography. CONCLUSIONS: Greyish spherical deposits on the vitreoretinal interface have been previously described as inflammatory reactions in asymptomatic human T-lymphotropic virus type I (HTLV-1) carriers and in patients with HTLV-1-associated uveitis. For the first time, optical coherence tomography (OCT) provided clinical correlation of this unusual presentation of toxoplasmic chorioretinitis.

Primary orbital melanoma treated with iodine-125 plaque radiotherapy.

PURPOSE: To report a case of primary orbital melanoma successfully managed by custom-designed iodine-125 plaque. DESIGN: Case report. METHODS: A 59-year-old man with no systemic or secondary melanocytic tumor was diagnosed with primary orbital melanoma after transconjunctival incisional biopsy. He was treated with unshielded iodine-125 plaque (90 Gy) that was sutured to the sclera. The radiation plan was calculated to safely target the initial tumor volume and any residual intrascleral or loose orbital melanoma cells that could have been disseminated to the surrounding orbital tissues during incisional biopsy. RESULTS: After 66 months' follow-up, the patient was still alive with partial remission of his liver metastases. Routine orbital magnetic resonance imaging studies confirmed the lack of orbital recurrence. CONCLUSIONS: Plaque radiotherapy appears to be a reasonable alternative to exenteration or external irradiation for orbital melanoma after biopsy confirmation.

Solid cast-forming actinomycotic canaliculitis: case report.

Solid-cast forming actinomycotic canaliculitis is an uncommon cause of unilateral chronic red eye resistant to conventional topical medical therapy. The authors report the history of a 62-year old woman who was complaining of mucopurulent discharge from the right lower canaliculus for a period of 12 months. Culture yielded a few colonies of Actinomyces. Magnetic resonance imaging showed a dilation of the right lower canaliculus. The signal was hypointense and heterogeneous on both T1 and T2 weighted sequences. Surgery enabled removal of several solid yellowish casts and resulted in resolution of the disease. Histopathologic examination confirmed the presence of dense, basophilic conglomerates of filamentous organisms. Because rhinologists have more and more opportunities to perform surgery of the lachrymal pathway they need to be informed about this clinical entity.