Endoscopic optic nerve decompression for traumatic optic neuropathy: an alternative.
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Adult↗
Biomedical subjects
Dinesh Selva
Publications and source records attributed to Dinesh Selva.
Wegener's granulomatosis: ophthalmic manifestations and management.
OBJECTIVES: To provide an up-to-date and comprehensive review of Wegener's granulomatosis (WG) as a disease entity, focusing on the ophthalmic manifestations and management options. METHODS: A search of Medline was undertaken between 1966 and 2005 regarding WG, systemic vasculitis, and the ocular manifestations of WG. Major ophthalmic and medical textbooks also were reviewed for content, as well as original references. RESULTS: Involvement of ocular and orbital structures in patients with WG is common and may be a presenting feature. The ocular manifestations range from mild conjunctivitis and episcleritis to more severe inflammation with keratitis, scleritis, uveitis, and retinal vasculitis. Involvement of the nasolacrimal system and orbital tissues also can occur. Except for some cases of anterior segment inflammation, the ocular involvement will not respond to topical agents, but rather to systemic antiinflammatory and immunosuppressive regimens. Surgical intervention may be of value for obtaining tissue diagnosis, in achieving orbital decompression in cases of significant orbital disease with optic nerve compromise, or in cases of nasolacrimal duct obstruction. CONCLUSION: WG is an important clinical entity that needs to be recognized early and treated appropriately. Ophthalmic manifestations are frequently encountered and can result in significant morbidity and even blindness. The management is challenging and often requires a multidisciplinary approach.
Diagnosis, Differential↗
Ocular adnexal Langerhans cell histiocytosis clinical features and management.
PURPOSE: To review the clinical features, investigations, management, and outcomes of Langerhans cell histiocytosis (LCH) with ocular adnexal involvement. MATERIALS AND METHODS: Retrospective, non-comparative, chart review of 30 patients with LCH involving the ocular adnexa treated at 6 major Australian hospitals. Clinical features, imaging findings, treatment, local and distant recurrence and outcome were evaluated. RESULTS: Twenty-four patients (80%) were male with a mean age of presentation of 9.5 years. Females presented at an earlier age (mean age 4.1 years) with more severe involvement. Eighty percent of the cases presented with periorbital swelling. Computed tomography usually showed destructive osteolytic lesions centred on the frontal bone. Twenty-four patients (80%) had unifocal, unisystem disease. From this group, none of 13 treated with excision alone had recurrence whereas 2 of 6 treated with excision followed by chemotherapy recurred. CONCLUSIONS: Unifocal, unisystem LCH often presents to the ophthalmologist and can usually be diagnosed on clinical and imaging grounds. Computed tomography and magnetic resonance imaging are complementary imaging studies. Biopsy is essential to confirm diagnosis. Unifocal, unisystem disease can be treated with local excision and curettage. Incomplete excision, recurrent disease or multifocal disease may require systemic chemotherapy.
Adolescent↗
Novel technique to control hypersecretion from a transplanted autologous submandibular salivary gland for keratoconjunctivitis sicca.
PURPOSE: To present a novel technique to control hypersecretion from a transplanted autologous submandibular gland (SMG) in a patient with keratoconjunctivitis sicca. METHODS: A 65-year-old man presented with corneal epithelial edema and suspicious ocular surface dysplasia secondary to hypersecretion from a transplanted autologous SMG. The location and function of the gland were evaluated perioperatively using technetium-99m-pertechnetate scintigraphy. The course of the duct was marked with a radiation probe, surgically exposed, and partially ligated with titanium clips. RESULTS: Marked reduction in salivary flow and resolution of corneal edema and ocular surface changes were noted. Conjunctival biopsy showed no evidence of malignancy. Symptoms were stable during a 1-year follow-up period. CONCLUSION: Partial ligation of the transplanted SMG duct may be a simple and reversible technique to control hypersecreting glands with secondary corneal edema and ocular surface changes.
Aged↗
Intraepithelial sebaceous carcinoma of the eyelid misdiagnosed as Bowen's disease.
BACKGROUND: Sebaceous carcinoma (SC) is well known for its ability to masquerade clinically and histologically as a variety of periocular conditions resulting in a delayed diagnosis. We present a series of periocular SC cases and discuss the difficulties in histopathological diagnosis when this tumor presents with a Bowenoid pattern of intraepithelial spread. METHODS: A retrospective case study of all patients with SC of the eyelid treated in our Hospital, from 1997 to 2004, was conducted. RESULTS: Eight patients were identified (four females and four males). Seven cases involved the upper eyelid. Initial clinical diagnoses included blepharitis (three cases), blepharoconjunctivitis (one case), cicatrizing conjunctivitis (one case), and lid lesions (two cases). Histopathologically, 87.5% of cases were misdiagnosed as Bowen's disease (BD) on the initial biopsy. Six of these cases showed no invasive disease on the initial biopsy and were eventually found to be invasive SC on subsequent excisions. In one case, the tumor was wholly in situ. Delay in diagnosis ranged from 0 to 56 months. CONCLUSIONS: SC should always be considered in the histological differential diagnosis of any eyelid lesion which resembles BD, particularly if the upper eyelid is involved or if multivacuolated cytoplasmic clear cell changes are seen.
Adenocarcinoma, Sebaceous↗
Multifocal objective perimetry compared with Humphrey full-threshold perimetry in patients with optic neuritis.
BACKGROUND: The aim of the study is to compare multifocal visual evoked potential (mfVEP) objective perimetry with Humphrey full-threshold visual field (HVF) perimetry, in the assessment of patients with optic neuritis (ON). METHODS: We assessed 16 patients with clinically diagnosed ON. A comparison was made between the HVF and mfVEP, based on the global severity indices of both tests and number and topography of significant abnormalities detected. The latency data and inter-eye asymmetry findings on the mfVEP were also evaluated. RESULTS: From a total of 128 quadrants analysed in the 16 patients (100 affected, 28 unaffected eyes), HVF perimetry identified a scotoma in 39/128 (30.5%) quadrants, all of which were in affected eyes; the mfVEP detected a scotoma in 68/128 (53.1%) quadrants using amplitude and/or asymmetry data (XV2=7.2485, P=0.0071). Latency plots on the mfVEP identified a significant latency deviation cluster in 20/25 (80%) affected eyes. Abnormalities were also detected in 4/7 (57%) unaffected eyes. The global severity indices in the affected eyes showed a high correlation between the two tests (r=0.73). CONCLUSIONS: The mfVEP detected more abnormalities in patients with ON than HVF perimetry. The use of latency recordings as well as combined amplitude and asymmetry plots is advantageous and has the potential to detect abnormalities not otherwise detected on HVF perimetry.
Adolescent↗
Prevalence of trachoma among a group of Aboriginal school children in remote South Australia.
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Adolescent↗
Mitomycin C in dacryocystorhinostomy.
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Alkylating Agents↗
The Australian Mohs database: short-term recipient-site complications in full-thickness skin grafts.
BACKGROUND: There are only a few reports on the outcome with full-thickness skin grafts (FTSG) in defect reconstruction after Mohs micrographic surgery (MMS). OBJECTIVES: The objective was to evaluate the complications with FTSG in patients treated with MMS for cutaneous tumors. METHODS: This study is based on a prospective data collection of all patients in Australia treated with MMS and monitored by the Skin and Cancer Foundation, between 1993 and 2002. Primary outcome measures were FTSG recipient-site complications (partial/complete graft failure, graft infection, acute bleeding/hematoma, graft hypertrophy, and graft contracture). RESULTS: The study group included 2,673 patients (50.2% men) with a mean age of 64+/-14 years. Most tumors were basal call carcinoma (90.9%) and were located on the nose (63.8%), periocular area (14.8%), or auricular area (8.1%). A total of 11.7% of cases had recipient-site complications (graft hypertrophy, 42.3%; partial graft failure, 27.2%; graft contraction, 15.3%). Only 45.2% of complicated cases required treatment. CONCLUSION: Short-term recipient-site complications occurred in less than 12% of reconstructions with FTSG. Graft hypertrophy and partial graft failure accounted for most cases of complications. The authors have indicated no significant interest with commercial supporters.
Adolescent↗
Scalp tumors treated with Mohs micrographic surgery: clinical features and surgical outcome.
BACKGROUND: There are only a small number of reports on the outcome of scalp tumors treated with Mohs micrographic surgery (MMS). OBJECTIVE: The objective was to present a large series of patients with scalp tumors treated with MMS in Australia between 1993 and 2002. METHODS: This prospective, multicenter study included all patients with scalp tumors who were monitored by the Skin and Cancer Foundation Australia. The variables analyzed were patient demographics, reason for referral, preoperative tumor size and postoperative defect size, recurrences before MMS, histologic subtypes, perineural invasion, and 5-year recurrence. RESULTS: The study included 316 patients (68% men) with a mean age of 65+/-15 years. The most common tumors were basal cell carcinoma (BCC), 57.9%; squamous cell carcinoma (SCC), 35.8%; Bowen's disease (BD), 4.1%; and atypical fibroxanthoma (AFX), 1.6%. Recurrent tumors comprised 37% of cases. The recurrence rate for 70 BCC patients who completed the 5-year follow-up was 5.7%, and for 31 SCC cases it was 3.2%. No cases of recurrence were noted in the patients with BD and AFX. CONCLUSION: BCC was the most common scalp tumor managed by MMS. The low 5-year recurrence rate emphasizes the importance of margin controlled excision of scalp tumors.
Adult↗
Visual outcomes with the yellow intraocular lens.
PURPOSE: To compare postoperative best distance visual acuity (VA), contrast sensitivity and colour perception with the blue light-filtering AcrySof Natural (SN60AT) and AcrySof single-piece (SA60AT) intraocular lenses (IOLs). METHODS: This was a prospective, randomized, comparative, interventional study comparing postoperative performance between the SN60 and SA60 IOLs. There were nine patients (nine eyes) in the SN60 group and 10 patients (10 eyes) in the SA60 group. All patients were operated using phacoemulsification. Postoperative VA (Snellen chart), contrast sensitivity (Pelli-Robson contrast sensitivity chart) and colour perception (Farnsworth-Munsell D-15 panel test) were measured at 1, 3 and 6 months postoperatively. RESULTS: Postoperative best corrected VA after 6 months was 20/20 or better in 89% of SN60 eyes and 100% of SA60 eyes. Postoperative contrast sensitivity scores improved significantly in both groups under both photopic and mesopic conditions. There were no statistically significant differences in contrast sensitivity scores between the SN60 and SA60 groups at any of the postoperative evaluation time-points. Postoperative colour perception improved significantly in both the SN60 and SA60 groups, and there were no statistically significant differences in colour perception performance between the two groups. CONCLUSION: The blue light-filtering AcrySof Natural (SN60) IOL has postoperative visual performance comparable with that of the AcrySof single-piece (SA60) IOL.
Acrylic Resins↗
An unusual presentation of periocular Merkel cell carcinoma.
AIM: Merkel cell carcinoma (MCC) is an uncommon but potentially aggressive tumor. We describe a rare presentation of MMC of the upper lid. METHODS: A 63-year-old male presented with a 3-month history of right upper lid fullness. Examination revealed a large multinodular mass protruding into the conjunctival aspect of the eyelid. An enlarged right submandibular lymph node was also noted. RESULTS: An incisional biopsy was suggestive of MCC. Staged surgical excision with rapid paraffin sections was performed. The tumor cells were seen invading the tarsal plate and adjacent to the palpebral conjunctiva but not into the epidermis. MCC was confirmed using immunohistochemical stains and neuroendocrine markers (cytokeratins Cam 5.2, AE1/3, CK20, chromogranin, synaptophysin, and Leu 7). The lymph node biopsy was also confirmed as metastatic MCC. The patient was treated with postsurgical chemotherapy and radiotherapy, with no recurrence during a 6 months follow-up period. CONCLUSION: Although uncommon, periocular MCC may present as an atypical conjunctival multinodular mass.
Biomarkers, Tumor↗
Periocular microcystic adnexal carcinoma: management and outcome with Mohs' micrographic surgery.
PURPOSE: To report a series of patients with periocular microcystic adnexal carcinoma (MAC) treated with Mohs' micrographic surgery (MMS). DESIGN: Prospective, interventional case series. METHODS: This series included all patients treated with MMS for periocular MAC, who were monitored by the Skin and Cancer Foundation Australia between 1993 and 2002. RESULTS: There were 5 patients (4 males, 1 female) with a mean age of 52 +/- 12 years. Four tumors were located in the medial canthus and one in the lower lid. The tumor was initially misdiagnosed as basal cell carcinoma in 3 patients and squamous cell carcinoma in 1 patient. The average number of excision levels required for complete removal of the tumor during MMS was 2.2 (range 1-6). Perineural invasion was recorded in one patient.Five-year follow-up data was available for 3 patients, and there was no tumor recurrence in any of these cases. CONCLUSION: The low 5-year recurrence rate of periocular MAC with MMS emphasizes the importance of margin-controlled excision of this tumor.
Carcinoma, Skin Appendage↗
Deep lamellar keratoplasty in the treatment of keratoconus.
PURPOSE: To present our experience with a series of patients treated with deep lamellar keratoplasty (DLK) for keratoconus (KC). DESIGN: A single surgeon, prospective, consecutive series. METHOD: The study included all patients with KC who underwent DLK between March 1999 and November 2003 at the Royal Adelaide Hospital. The parameters evaluated included patients' demographics, pre- and post-operative best corrected visual acuities, post-operative keratometry, and intra- and post-operative complications. RESULTS: There were 22 patients (23 eyes); 10 females and 12 males, with a mean age of 35 +/- 13 years (median, 33.5; range, 17-73). The median follow-up period was 13 months (range 7-38). In 89% (16/18) of eyes which underwent DLK, and in which a visual acuity could be obtained, a best corrected visual acuity of at least 6/12 was recorded. There were two episodes of Descemet's membrane perforation (8.7%), in which the procedure was converted to penetrating keratoplasty without complications. One patient developed a double anterior chamber, which resolved spontaneously without consequences. CONCLUSION: The visual outcomes and complication rates seen in our series are comparable to the recent published literature. Hence DLK can be considered as a suitable alternative to penetrating keratoplasty for the surgical treatment of KC.
Adolescent↗
Mitomycin: clinical applications in ophthalmic practice.
Mitomycin (mitomycin C; MMC) is an antibiotic isolated from Streptomyces caespitosus. The drug is a bioreductive alkylating agent that undergoes metabolic reductive activation, and has various oxygen tension-dependent cytotoxic effects on cells, including the cross-linking of DNA. It is widely used systemically for the treatment of malignancies, and has gained popularity as topical adjunctive therapy in ocular and adnexal surgery over the past 2 decades. In ophthalmic medicine, it is principally used to inhibit the wound healing response and reduce scarring of surgically fashioned ostia. Hence, it has been used as adjunctive therapy in various ocular surgeries, such as glaucoma filtering surgeries, dacryocystorhinostomy, corneal refractive surgery and surgeries for ocular cicatrisation. In addition, it has been used as an adjunct in the surgical management of pterygia, ocular surface squamous neoplasia, primary acquired melanosis with atypia and conjunctival melanoma. In many of these surgeries and ophthalmic pathologies, MMC showed a significant beneficial effect.
Antibiotics, Antineoplastic↗
Pharmacological treatments for thyroid eye disease.
Thyroid eye disease (TED), which affects the majority of patients with Grave's disease, is associated with significant ophthalmic morbidity. In patients with mild disease, supportive treatment with lubricating medication can be sufficient. However, in patients with severe TED and disfiguring proptosis or sight-threatening neuropathy, more aggressive medical or surgical interventions are necessary. Corticosteroids remain the preferred pharmacological treatment modality in the majority of patients with an active inflammatory component. Other immunosuppressive drugs in combination with corticosteroids may be helpful in patients with corticosteroid-resistant TED. Newer agents such as somatostatin analogues have not shown to be of significant clinical benefit; however, initial studies on the use of antioxidants and cytokine antagonists are encouraging.
Adrenal Cortex Hormones↗
Allergic reaction to hyaluronidase: a rare cause of orbital inflammation after cataract surgery.
PURPOSE: The aim of this study was to present a series of patients with acute orbital inflammatory symptoms secondary to peribulbar hyaluronidase allergy and to discuss the diagnostic and management modalities. METHODS: Review of clinical records of all patients with acute orbital inflammatory symptoms after uneventful cataract surgery, seen at two ophthalmology departments. The main outcome measures included clinical signs and symptoms, imaging findings, post-operative course, skin allergy testing, and final outcome. RESULTS: There were five patients (four women, one man) with a mean age of 78+/-7.0 years. Signs and symptoms appeared 12-72 h after cataract surgery and included axial proptosis, periorbital erythema with swelling, and extraocular muscle (EOM) function restriction (5/5), periorbital pain or itchiness (3/5), and conjunctival chemosis (4/5). Computerized tomography showed increased orbital fat haziness and enlargement of EOM. Treatment with a combination of oral antibiotics and steroids or antihistamines resulted in resolution of signs and symptoms after 3-5 days. Intradermal and/or skin prick allergy tests were positive for hyaluronidase and negative for all other perioperative medications used. CONCLUSION: Although uncommon, allergy to peribulbar hyaluronidase injected during cataract surgery should be considered in the differential diagnosis of patients who present with acute post-operative orbital signs and symptoms.
Aged↗
Entopic phenomenon as initial presentation of acute myelogenous leukemia.
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Adult↗