Pilomatrix carcinoma of the lacrimal caruncle: a case report / Carcinoma pilomatricial da carúncula lacrimal: relato de caso

ABSTRACT A 45-year-old man presented with a 3-month history of a mass located in the caruncle of his right eye. An incisional biopsy had been performed one month prior by another specialist, and the histopathology report showed basal cell carcinoma. The mass was completely excised with a 2 mm safety margin, and the large conjunctival defect was reconstructed with one sheet of amniotic membrane allograft. A histological diagnosis of pilomatrix carcinoma was established. To prevent recurrence after surgery, we added bevacizumab (25 mg/mL, 1.25 mg/mL per drop) eye drops four times per day for three months. At the one-year follow-up, the patient showed no evidence of local recurrence or distant metastasis after initial excision and remains under close follow-up. Pilomatrix carcinoma should be considered in the differential diagnosis of a caruncular mass.

RESUMO Um homem de 45 anos apresentou história de massa na carúncula no olho direito durante 3 meses. Uma biópsia incisional foi realizada 1 mês antes por outro especialista e o laudo histopatológico mostrava carcinoma basocelular. A massa foi completamente excisada, com uma margem de segurança de 2 mm, e a grande lesão conjuntival foi reconstruída com uma folha de aloenxerto de membrana amniótica. Foi estabelecido um diagnóstico histológico de carcinoma pilomatricial. Para evitar a recorrência após a cirurgia, adicionamos colírio de bevacizumabe (25 mg/mL, 1,25 mg/mL por gota) quatro vezes ao dia durante três meses. No seguimento de 1 ano, o paciente não apresentou evidência de recidiva local ou metástase distante após a excisão inicial e continua sob acompanhamento próximo. O carcinoma pilomatricial deve ser considerado no diagnóstico diferencial de uma massa caruncular.

Pilomatrix carcinoma of the lacrimal caruncle: a case report.

A 45-year-old man presented with a 3-month history of a mass located in the caruncle of his right eye. An incisional biopsy had been performed one month prior by another specialist, and the histopathology report showed basal cell carcinoma. The mass was completely excised with a 2 mm safety margin, and the large conjunctival defect was reconstructed with one sheet of amniotic membrane allograft. A histological diagnosis of pilomatrix carcinoma was established. To prevent recurrence after surgery, we added bevacizumab (25 mg/mL, 1.25 mg/mL per drop) eye drops four times per day for three months. At the one-year follow-up, the patient showed no evidence of local recurrence or distant metastasis after initial excision and remains under close follow-up. Pilomatrix carcinoma should be considered in the differential diagnosis of a caruncular mass.

Ischemic optic neuropathy in robotic-assisted gynaecologic surgery: A case report.

The study was aimed to present a rare case of who developed non arteritic anterior ischemic optic neuropathy (NAION) following robotic-assisted gynaecologic surgery. A 58-year-old female patient presented with vision loss in right eye after non-complicated robotic-assisted total hysterectomy and bilateral salpingo-oopherectomy. We observed on fundoscopy optic disc edema and splinter hemorrhages at the optic disc edges. Fluorescein angiography showed hypofluorescence of the optic disc in the early phases due to filling delay followed by hyperfluorescence with leakage from disc capillaries in the late phases of the angiogram. From these findings, we diagnosed NAION in the right eye. When NAION was diagnosed, the patient received intravenous methylprednisolone. Topical brimonidin and coenzyme-Q were given. On 1-month follow-up, recovery of visual loss was observed. Here, we present a case of NAION that is an uncommon cause of perioperative visual loss after robotic-assisted gyneacologic surgery.

Use of topical bevacizumab for conjunctival intraepithelial neoplasia.

PURPOSE: To report our experience in the treatment of intraepithelial neoplasia of the conjunctiva using topical bevacizumab. METHODS: Ten eyes of 10 patients with conjunctival neoplasia received 25 mg/mL bevacizumab topically. Changes in the lesions were documented weekly using digital photography. After topical treatment, excisional biopsy was performed. RESULTS: The mean age of the patients was 60.5 ± 12 (33-77) years. The mean duration of topical treatment was 7.8 ± 1.3 (5-14) weeks. The size and vascularity of the tumors reduced weekly. All patients underwent excisional biopsy, cryotherapy, and amnion membrane transplantation. The histopathologic diagnosis of the lesions was carcinoma in situ. No recurrence was observed during the follow-up of patients for 6 months. CONCLUSIONS: Topical bevacizumab is an effective treatment to reduce the tumor size before surgery and may be a good alternative for adjuvant therapy of conjunctival neoplasms.

Intravitreal injection of methotrexate in an experimental rabbit model: determination of ultrastructural changes.

PURPOSE: To investigate the ultrastructural changes of the rabbit retina induced by intravitreal methotrexate injection. MATERIALS AND METHODS: Ten New Zealand white rabbits were enucleated bilaterally at different time periods after intravitreal methotrexate injection. One rabbit was used as control group and one rabbit was used as intact group. Histopathological examinations were performed under light and electron microscopy. Early (within first three days after injection) and long-term (one month after serial injections) effects of intravitreal methotrexate on the retina were investigated. RESULTS: Retinal edema, vacuolization, and disintegration of mitochondria of the retinal cells were observed as early changes. The main long-term effects after serial injections were edema in the photoreceptor, inner nuclear, and ganglionic cell layers. Cellular disorganisation was seen on light microscopy. Electron microscopic examination revealed mitochondrial degeneration and vacuole formation in retinal cells, nuclear degeneration in outer nuclear layer, and membranous whorl formation in photoreceptor and nerve fiber layers. CONCLUSIONS: High dose intravitreal methotrexate injection may cause significant ultrastructural changes in the rabbit retina in varying severity. This finding may highlight the potential side effects of methotrexate on human retina in higher doses.

Intravitreal injection of methotrexate in an experimental rabbit model: determination of pharmacokinetics.

PURPOSE: To investigate the pharmacokinetics of intravitreally administered methotrexate. MATERIALS AND METHODS: Twenty-one New Zealand white rabbits were used in the study. The pharmacokinetics of intravitreally injected 800 µg/0.1 ml of methotrexate was investigated. Intravitreal concentration of the drug was measured at seven different times, in six eyes at each occasion, on a total of 42 eyes of 21 rabbits from a period of 30 minutes to 72 hours. RESULTS: The volume of distribution was calculated as 1.33 ml following intravitreal injection of 800 µg methotrexate. Vitreous concentrations of the drug were found to be decreasing related to the specific mathematical equation; drug concentration= 1426.73 e -0.1182(time) and remained over effective dose by 81 hours with a half life of 5.9 hours. CONCLUSIONS: These findings evidenced those vitreous levels of methotrexate at various time intervals after 800 µg intravitreal injections which formulated a mathematical equation for calculation of vitreous level of the drug at each hour.

Severe acute corneal hydrops in a patient with Down syndrome and persistent eye rubbing.

We report a case of severe acute corneal hydrops in an 11-year-old boy with keratoconus associated with Down syndrome and vigorous eye rubbing. Complete resolution of the corneal edema and a central corneal scar was seen in the 8th week of final follow-up. Eye-rubbing may play a role in the pathogenesis of acute hydrops, and conventional therapy can be successful in its management, even in severe cases.

Management of severe allergic conjunctivitis with topical cyclosporin a 0.05% eyedrops.

PURPOSE: To evaluate the efficacy of topical cyclosporin A 0.05% in the management of severe allergic conjunctivitis. METHODS: Seven patients with severe allergic conjunctivitis who were not responding to topical steroids, antihistamines, and mast cell stabilizers were given topical cyclosporin A 0.05%. All patients had an active disease when they were included in the study. Signs and symptoms were recorded before and after treatment. RESULTS: Seven patients, 6 boys and 1 girl, 6-14 years old, 6 with vernal keratoconjunctivitis and 1 with atopic keratoconjunctivitis, were enrolled in the study. Treatment with topical cyclosporin A 0.05% decreased the severity of symptoms and clinical signs significantly after 6 months (P < 0.05, Wilcoxon signed rank test). In addition, the need for steroids was reduced or even stopped. The patients experienced no side effects during the follow-up periods (mean, 14.0 +/- 2.1 months; range, 8-18 months). CONCLUSIONS: Topical cyclosporin A is an effective treatment in the management of severe allergic conjunctivitis with a benefit as a steroid-sparing agent.

Bilateral choroidal infiltration from indolent non-Hodgkin's lymphoma: a rapid course with poor prognosis.

A 42-year-old-woman, with a 2 year history of non-Hodgkin's lymphoma suffered sudden bilateral visual loss. This unusual patient presented with an unifocal choroidal tumor in the superionasal quadrant in both eyes. Fluorescein angiography revealed early and late intense subretinal fluorescence. Cytological examination of the anterior chamber and vitreous tap material revealed abnormal lymphocytes compatible with NHL. Diffuse choroidal infiltration was diagnosed and treated with radiotherapy. Radiotherapy did not provide local control and preservation of the vision. Non-Hodgkin's lymphoma can infiltrate to the choroid and radiotherapy may not be efffective in every case.

Surgical management of scleral defects.

PURPOSE: To evaluate the results of surgical management of scleral defects using fascia lata, cornea, and sclera as graft materials. METHODS: The scleral defects of 8 patients were repaired surgically. Six had previous intraocular surgery, 1 had eye trauma, and the other had both intraocular surgery and trauma. Corneoscleral grafts were used in 3 eyes, scleral grafts in 4, and fascia lata was used in 1 eye. RESULTS: In 7 patients, we achieved the desired cosmetic and tectonic success. During the follow-up period, a recurrent defect was seen in 1 patient, and a second operation was required. CONCLUSIONS: Surgical techniques using fascia lata, corneal, and scleral grafts are effective for scleral defects.

Visual acuity and corneal topographic changes related with pterygium surgery.

PURPOSE: Applied pre- and postoperative corneal topography outcomes with visual acuities were evaluated to determine the surgical results in pterygium therapy. METHODS: The study group consisted of 30 eyes of 26 patients with primary and recurrent pterygium. Mean patient age was 52.26+/-11.50 years (range: 27 to 68 years). Pre- and postoperative visual acuity and comeal topography were evaluated for each case. Statistical analysis was performed using the repeated-measure test. RESULTS: The mean uncorrected visual acuity was 0.41+/-0.30 preoperatively and 0.63+/-0.26 postoperatively (P<.001). The mean best spectacle-corrected visual acuity was 0.59+/-0.28 preoperatively and 0.84+/-0.22 postoperatively (P<.001). Surface regularity index ranged from 1.96+/-1.08 preoperatively to 1.09+/-0.76 postoperatively (P<.001). The mean surface asymmetry index was 3.05+/-2.85 preoperatively and 1.39+/-1.70 postoperatively (P=.003). The mean topographic astigmatism was 4.65+/-3.02 preoperatively and 2.33+/-2.26 postoperatively (P=.003). CONCLUSIONS: Examination of the topographic records reveals pterygium-associated corneal flattening in the horizontal meridian along the line of the pterygium. The improvement in topographic pattern and best spectacle-corrected visual acuity can be used as one indicator of the success of pterygium surgery.

Interleukin (IL)-6, interleukin (IL)-8 levels and cellular composition of the vitreous humor in proliferative diabetic retinopathy, proliferative vitreoretinopathy, and traumatic proliferative vitreoretinopathy.

PURPOSE: To investigate the interleukin (IL)-6 levels, IL-8 levels, and cellular composition of the vitreous humor in patients with proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR), and traumatic PVR. METHODS: Vitreous samples from 14 patients with PDR, 10 patients with PVR, and 10 patients with traumatic PVR were analyzed. Fifteen cadaver eyes were used as controls. Cytokine levels were measured by ELISA. RESULTS: Elevated IL-6 levels were detected in the vitreous of 12 (85.7%) of the PDR patients, eight (80%) of the PVR patients, and all (100%) of the traumatic PVR patients. None of the control IL-6 results were elevated. Vitreous IL-8 levels were elevated in 12 (85.7%) of the PDR patients, six (60%) of the PVR patients, all (100%) of the traumatic PVR patients, and one (6.7%) of the control eyes. Cytological examination of the vitreous specimens revealed a predominance of macrophages (50%) in the PDR samples and a predominance of retinal pigment epithelial (RPE) cells (60%) in the PVR samples. In contrast, neutrophils predominated (88%) in the traumatic PVR samples. CONCLUSION: The findings suggest that IL-6 and IL-8 may be involved in the pathogenesis of PDR, PVR, and traumatic PVR. High proportions of RPE cells and macrophages are associated with elevated IL-6 and IL-8 levels in the vitreous of PDR and PVR patients; however, the fact that these cells are not predominant in traumatic PVR suggests that different immune response mechanisms may be active in the pathogenesis of these disorders.

Lacrimal intubation with the Ritleng system in recurrent congenital nasolacrimal duct obstruction in children.

PURPOSE: To evaluate the efficacy of the Ritleng lacrimal intubation system in the treatment of congenital nasolacrimal duct obstruction. METHODS: Twenty-six patients (29 eyes) with congenital nasolacrimal duct obstruction, who ranged in age from 2 to 12 years (mean, 4.85 +/- 2.9 years), underwent silicone intubation with the Ritleng lacrimal intubation system. The Ritleng lacrimal intubation system is composed of a Ritleng probe, a monofilament guide thread and a silicone tube. The prolene tip was removed from the inferior meatus with nasal endoscopy in 26 eyes, whereas this was done by using a Ritleng hook in 3. Clinical success was defined by the relief from symptoms and signs of obstruction. The tubes were left in place for an average of 6 months. The patients were followed up between 6 and 25 months (mean, 8.3 months). RESULTS: All cases were successfully intubated with the Ritleng system. Two cases underwent reintubation because of tube dislocation during the first week. Granuloma developed at the edge of the inferior punctum in 1 case. We observed relief from symptoms in all cases. CONCLUSION: The Ritleng lacrimal intubation system is an easy, effective and nontraumatizing procedure for the treatment of congenital nasolacrimal duct obstruction.

Using diazepam and atropine before strabismus surgery to prevent postoperative nausea and vomiting: a randomized, controlled study.

OBJECTIVE: To evaluate the efficacy of diazepam and atropine sulfate premedication in preventing nausea and vomiting after strabismus surgery under general anesthesia. METHODS: Fifty children age 4 to 15 years who underwent strabismus surgery at Cukurova University Medical Faculty, Department of Ophthalmology, from February 2000 to June 2000 were randomized into 2 groups: 25 children in the control group did not receive premedication, whereas 25 children in the treatment group received premedication with 0.15 mg/kg diazepam and 0.015 mg/kg atropine sulfate. Occurrence of postoperative nausea and vomiting (PONV) was recorded. RESULTS: The incidence of PONV was lower in the premedicated group (P <.018, chi(2) test). CONCLUSIONS: It is concluded that diazepam and atropine sulfate premedication decreases nausea and vomiting after strabismus surgery.