Primary signet ring cell carcinoma of the eyelid.

Primary signet ring cell carcinoma of the eyelid (PSCE) is a very rare tumour. Only a few cases having been reported to date. The majority of patients have been middle-age to elderly men. Different treatment modalities have been applied in cases of PSCE. Here, we report a case of PSCE in a man treated with orbital exenteration and radiotherapy.

Risk of age-related macular degeneration 3 years after cataract surgery: paired eye comparisons.

OBJECTIVE: To clarify possible associations between cataract surgery and progression of age-related macular degeneration (AMD). DESIGN: Clinic-based cohort. PARTICIPANTS: We followed cataract surgical patients aged 65+ years in the Australian Cataract Surgery and Age-related Macular Degeneration (CSAMD) study. Patients who remained unilaterally phakic for at least 24 months after recruitment were included. METHODS: We performed annual examinations with retinal photography. We assessed AMD using side-by-side grading of images from all visits. Paired comparisons between operated and nonoperated fellow eyes (defined as nonoperated or operated <12 months previously) were made using generalized estimating equation models. MAIN OUTCOME MEASURES: Incident early AMD was defined as the new appearance of soft indistinct/reticular drusen or coexisting retinal pigmentary abnormality and soft distinct drusen in eyes at risk of early AMD. Incident late AMD was defined as the new appearance of neovascular AMD or geographic atrophy (GA) in eyes at risk of late AMD. RESULTS: Among 2029 recruited, eligible participants, 1851 had cataract surgery performed at Westmead Hospital, Sydney, and 1244 (70.7%) had 36-month postoperative visits. Of these participants, 1178 had gradable photographs at baseline and at least 1 follow-up visit. Of 308 unilaterally operated participants at risk of late AMD, this developed in 4 (1.3%) operated and 7 (2.3%) nonoperated fellow eyes (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.23-2.36) after adjusting for the presence of early AMD at baseline. Of 217 unilaterally operated participants at risk of early AMD, this developed in 23 (10.6%) operated and 21 (9.7%) nonoperated fellow eyes (OR, 1.07; 95% CI, 0.74-1.65). Incident retinal pigment abnormalities were more frequent in operated than nonoperated fellow eyes (15.3% vs. 9.9%; OR, 1.64; 95% CI, 1.07-2.52). There was no difference in the 3-year incidence of large soft indistinct or reticular drusen between the 2 eyes (8.8% vs. 7.9%; OR, 1.12; 95% CI, 0.79-1.60). CONCLUSIONS: Prospective follow-up data and paired eye comparisons of this older surgical cohort showed no increased risk of developing late AMD, early AMD, or soft/reticular drusen over 3 years. There was a 60% increased detection of retinal pigmentary changes in surgical eyes.

Dietary antioxidants and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study.

PURPOSE: To assess the relationship between baseline dietary and supplement intakes of antioxidants and the long-term risk of incident age-related macular degeneration (AMD). DESIGN: Australian population-based cohort study. PARTICIPANTS: Of 3654 baseline (1992-1994) participants initially 49 years of older, 2454 were reexamined after 5 years, 10 years, or both. METHODS: Stereoscopic retinal photographs were graded using the Wisconsin Grading System. Data on potential risk factors were collected. Energy-adjusted intakes of alpha-carotene; beta-carotene; beta-cryptoxanthin; lutein and zeaxanthin; lycopene; vitamins A, C, and E; and iron and zinc were the study factors. Discrete logistic models assessed AMD risk. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated after adjusting for age, gender, smoking, and other risk factors. MAIN OUTCOME MEASURES: Incident early, late, and any AMD. RESULTS: For dietary lutein and zeaxanthin, participants in the top tertile of intake had a reduced risk of incident neovascular AMD (RR, 0.35; 95% CI, 0.13-0.92), and those with above median intakes had a reduced risk of indistinct soft or reticular drusen (RR, 0.66; 95% CI, 0.48-0.92). For total zinc intake the RR comparing the top decile intake with the remaining population was 0.56 (95% CI, 0.32-0.97) for any AMD and 0.54 (95% CI, 0.30-0.97) for early AMD. The highest compared with the lowest tertile of total beta-carotene intake predicted incident neovascular AMD (RR, 2.68; 95% CI, 1.03-6.96; P = 0.029, for trend). Similarly, beta-carotene intake from diet alone predicted neovascular AMD (RR comparing tertile 3 with tertile 1, 2.40; 95% CI, 0.98-5.91; P = 0.027, for trend). This association was evident in both ever and never smokers. Higher intakes of total vitamin E predicted late AMD (RR compared with the lowest tertile, 2.83; 95% CI, 1.28-6.23; and RR, 2.55; 95% CI, 1.14-5.70 for the middle and highest tertiles, respectively; P = 0.22, for trend). CONCLUSIONS: In this population-based cohort study, higher dietary lutein and zeaxanthin intake reduced the risk of long-term incident AMD. This study confirmed the Age-Related Eye Disease Study finding of protective influences from zinc against AMD. Higher beta-carotene intake was associated with an increased risk of AMD.

Cardiovascular risk factors and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study.

PURPOSE: To assess the relationship between cardiovascular disease and cardiovascular risk factors, other than smoking, and risk of long-term incident age-related macular degeneration (AMD). DESIGN: Population-based cohort study. PARTICIPANTS: There were 3654 baseline (1992-1994) participants aged > or = 49 years included in the Blue Mountains region, west of Sydney, Australia. Of these, 2335 (75% of survivors) were reexamined after 5 years (1997-1999) and 1952 (76% of survivors) after 10 years (2002-2004). METHODS: Stereoscopic color fundus photographs were graded using the Wisconsin Age-related Maculopathy Grading System. History, physical examination, and fasting blood samples provided data on possible risk factors. Age-related macular degeneration incidence was calculated using the Kaplan-Meier survival approach. Discrete linear logistic models were used to assess risk of incident AMD. Relative risks (RR) and 95% confidence intervals (CI) are presented after adjusting for age, gender, smoking, and other risk factors. MAIN OUTCOME MEASURE: Incident early and late AMD. RESULTS: Increasing high-density lipoprotein (HDL) cholesterol was inversely related to incident late AMD (RR per standard deviation [SD] increase, 0.74; 95% CI, 0.56-0.99). Elevated total/HDL cholesterol ratio predicted late AMD (RR per SD increase, 1.35; 95% CI, 1.07-1.70) and geographic atrophy (GA; RR per SD, 1.63; 95% CI, 1.18-2.25). Diabetes predicted incident GA (RR, 3.89; 95% CI, 1.36-11.08), but not neovascular AMD. History of stroke (RR 2.01; 95% CI, 1.12-3.58), or any cardiovascular disease (stroke, myocardial infarction, or angina; RR, 1.57; 95% CI, 1.13-2.16) predicted incident early AMD and incident indistinct soft or reticular drusen (RR, 2.38; 95% CI, 1.33-4.27 for stroke; RR, 1.80; 95% CI, 1.28-2.52 for any cardiovascular disease). Neither pulse pressure, systolic or diastolic blood pressure, or presence of hypertension at baseline were associated with incident AMD. CONCLUSIONS: Our findings provide some evidence of links between cardiovascular risk factors and AMD. Further prospective evaluation of these relationships is warranted, as these findings could have therapeutic implications.

Smoking and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study.

OBJECTIVE: To assess the association between smoking and long-term incident age-related macular degeneration (AMD). METHODS: Of 3654 Australians 49 years and older examined at baseline (January 14, 1992, through December 18, 1993), 2454 were examined 5 years later (January 11, 1997, through February 23, 2000), 10 years later (July 10, 2002, through November 4, 2005), or both. Retinal photographs were taken to assess AMD. Smoking status was recorded at each interview. RESULTS: After controlling for age, sex, and other factors, current smokers had a 4-fold higher risk of late AMD than never smokers (relative risk, 3.9; 95% confidence interval, 1.7-8.8). Past smokers had a 3-fold higher risk of geographic atrophy (relative risk, 3.4; 95% confidence interval, 1.2-9.7). Joint exposure to current smoking and (1) the lowest level of high-density lipoprotein (HDL) cholesterol, (2) the highest total to HDL cholesterol ratio, or (3) low fish consumption was associated with a higher risk of late AMD than the effect of any risk factor alone. However, interactions between smoking and HDL cholesterol level, ratio of total to HDL cholesterol, and fish consumption were not statistically significant. CONCLUSION: Smoking strongly increased the long-term risk of incident late, but not early, AMD, with a possibly greater effect in persons with a low HDL cholesterol level, a high ratio of total to HDL cholesterol, and low fish consumption.

Statins and the long-term risk of incident age-related macular degeneration: the Blue Mountains Eye Study.

PURPOSE: To assess the relationship between statin use and the long-term incidence of age-related macular degeneration (AMD). DESIGN: Population-based cohort study. METHODS: Of 3,654 baseline (1992 to 1994) participants in the Blue Mountains Eye Study initially aged 49+ years, 2,335 were reexamined after five years (1997 to 1999) and 1,952 after 10 years (2002 to 2004). Stereoscopic macular photographs were graded using the Wisconsin Age-related Maculopathy Grading System. History, physical examination, and fasting blood samples provided data on possible risk factors. Discrete linear logistic models were used to assess risk of incident AMD. RESULTS: After controlling for age, gender, and other confounding factors, compared with nonusers, statin users had a reduced risk of developing indistinct soft drusen, the principal late AMD precursor lesion (hazard ratio, 0.33; 95% confidence interval, 0.13 to 0.84). CONCLUSIONS: Statin use was not significantly associated with overall early AMD incidence, but was protective for indistinct soft drusen, a key late AMD precursor lesion.

Statin use and the long-term risk of incident cataract: the Blue Mountains Eye Study.

PURPOSE: To assess the association between statin use and long-term incident cataract. DESIGN: Population-based cohort study. METHODS: Of 3,654 baseline (1992 to 1994) elderly participants in the Blue Mountains Eye Study (BMES), 2,335 (75% of survivors) were reexamined after five years (1997 to 1999) and 1,952 (76% of survivors) after 10 years (2002 to 2004). Lens photographs were taken and graded using the Wisconsin Cataract Grading System. History, physical examination, and fasting blood samples provided data on possible risk factors. Discrete linear logistic models were used to assess the risk of cataract. RESULTS: After controlling for age, gender, and other factors, statin use was protective for any cataract (hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.29-0.93), but was not significantly associated with incident nuclear (HR 0.66; CI 0.35 to 1.25), cortical (HR 0.76; CI 0.44 to 1.33), or posterior subcapsular (PSC) cataract (HR 1.47; CI 0.70 to 3.08). CONCLUSIONS: Statin use was found to reduce by 50% the risk of cataract development, principally nuclear or cortical cataract subtypes.

Dietary fatty acids and the 10-year incidence of age-related macular degeneration: the Blue Mountains Eye Study.

OBJECTIVE: To assess the relationship between baseline dietary fatty acids and 10-year incident age-related macular degeneration (AMD). METHODS: In an elderly Australian cohort, 3654 participants were examined at baseline and 2454 were examined 5 and/or 10 years later. We assessed AMD from retinal photographs. Participants completed a semiquantitative food frequency questionnaire. RESULTS: After adjusting for age, sex, and smoking, 1 serving of fish per week was associated with reduced risk of incident early AMD (relative risk, 0.69 [95% confidence interval, 0.49-0.98]), primarily among participants with less than the median linoleic acid consumption (0.57 [0.36-0.89]). Findings were similar for intake of long-chain omega-3 polyunsaturated fatty acids. One to 2 servings of nuts per week was associated with reduced risk of incident early AMD (relative risk, 0.65 [95% confidence interval, 0.47-0.91]). Protective associations between the intake of nuts and reduced risk of pigmentary abnormalities were seen among nonsmokers, participants with less than the median ratio of serum total to high-density lipoprotein cholesterol, and those with beta carotene intake greater than the median level. CONCLUSIONS: This study provides evidence of protection against early AMD from regularly eating fish, greater consumption of omega-3 polyunsaturated fatty acids, and low intakes of foods rich in linoleic acid. Regular consumption of nuts may also reduce AMD risk. Joint effects from multiple factors are suggested.

Influence of diabetes and cardiovascular disease on the long-term incidence of cataract: the Blue Mountains eye study.

PURPOSE: To assess associations between diabetes and selected cardiovascular risk factors and long-term incident cataract and cataract surgery. METHODS: A cohort of initially 3654 elderly Australians were followed over a period of 10 years. Questionnaires ascertained relevant history and fasting blood samples were taken. Impaired fasting glucose (IFG) and metabolic syndrome were defined using World Health Organization criteria. Discrete logistic models were used to assess risk of incident cataract. RESULTS: After controlling for age, sex, and other factors, baseline diabetes predicted nuclear cataract (relative risk, RR, 1.64; 95% confidence interval (CI), 1.02-2.64) and IFG predicted cortical cataract (RR, 2.01; CI, 1.20-3.36). Each standard deviation (SD) increase in glucose was positively associated with cortical cataract (RR, 1.13; CI, 1.01-1.27). Higher body mass index (BMI) was positively associated with posterior subcapsular cataract (RR per SD, 1.20; CI, 1.03-1.41). Persons using anti-hypertensive medication had a higher incidence of cataract surgery (RR, 1.61; CI, 1.18-2.20). Metabolic syndrome was associated with an increased risk of all 3 cataract subtypes. Few other significant associations were found between cardiovascular disease, cardiovascular risk factors, and incident cataract or cataract surgery. CONCLUSIONS: We confirmed diabetes as a risk factor for age-related cataract and IFG as a possible risk factor for cortical cataract. BMI and hypertension were also related to incident cataract. Overall, few associations were found between cardiovascular risk factors and long-term incident cataract. A cluster of metabolic abnormalities attributable to insulin resistance appears more likely to contribute to cataract formation than any individual cardiovascular risk factor alone.

Smoking and the long-term incidence of cataract: the Blue Mountains Eye Study.

PURPOSE: To assess the association between smoking and the long-term incidence of cataract and cataract surgery. METHODS: In a population-based cohort of Australians aged 49 years and over, 3654 participants were seen at baseline (1992-94) and 2406 were seen after 5- and/or 10-years and had photographs taken to assess incident cataract. Smoking status was recorded at interview. History, physical examination and fasting blood samples provided data on possible risk factors. Cataract incidence was calculated using the Kaplan-Meier survival approach. Discrete linear logistic models were used to assess risk of incident cataract. RESULTS: After controlling for age, sex and other factors, ever smokers had an increased risk of developing nuclear cataract compared to never smokers (relative risk (RR) 1.41; 95% confidence interval (CI) 1.09-1.83; RR 1.37, CI 1.04-1.81 for past smoking and RR 1.57, CI 1.06-2.31 for current smoking). The effect of smoking was strongest in ever smokers reporting 36 + pack-years of smoking compared to never smokers (RR 1.46; CI, 1.02-2.08). Current smokers also developed nuclear cataract slightly younger than non-smokers (mean age 65.2 versus 67.5 years, p = 0.049). No statistically significant associations were found between smoking status and the incidence of cortical or posterior subcapsular cataract, or cataract surgery. CONCLUSIONS: These epidemiological data confirm smoking as a modest risk factor for the development of nuclear cataract.