Retinal Choroidal Collateral Circulation After Radial Optic Neurotomy for Central Retinal Vein Occlusion

PURPOSE: To evaluate the incidence of retinal choroidal collateral circulation after radial optic neurotomy (RON) with central retinal vein occlusion (CRVO) patients and to correlate these collaterals with changes in visual acuity. METHODS: We conducted a retrospective study of 17 eyes of 17 consecutive patients diagnosed with CRVO who underwent RON after a standard three port-vitrectomy. Fundus examination and, FAG were performed to evaluate the incidence of retinal choroidal collateral circulation according to preoperative best corrected visual acuity. We evaluated changes in best corrected visual acuity according to chorioretinal circulation formation. RESULTS: Retinochoroidal shunts developed in 9 eyes (52.9%) at the site of radial optic neurotomy. The group whose initial visual acuity was better than 0.02 (72.7%) developed more shunts than the group whose initial visual acuity was under 0.02 (16.7%) (P=0.043). Changes in visual acuity were highly correlated with the development of collaterals from the retinal to choroidal circulation (P=0.008). CONCLUSIONS: Patients whose that initial visual acuity is better than 0.02 have more retinal choroidal collaterals. Surgical induction of retinochoroidal venous anastomosis may result in visual acuity improvement. Randomized studies are needed to compare the current study modality with the natural course of central retinal vein occlusion.

A Case of Primary Mucinous Adenocarcinoma of the Upper Eyelid

PURPOSE: We report a case of a recurrent, non-tender mass on the right upper eyelid, which was completely excised and histologically diagnosed as mucinous adenocarcinoma from the eccrine gland. METHODS: A 67-year-old man presented with a non-tender subcutaneous mass on the right upper eyelid, which had developed 6 months prior to presentation. A similar eyelid mass had also been removed one year earlier. We surgically removed some skin and the mass and conducted a biopsy. During the operation, the biopsy revealed it to be mucinous adenocarcinomas, and thus it was removed by Mohs' excision technique with a clean margin. RESULTS: A mucinous adenocarcinoma from the eccrine gland was diagnosed by a histologic examination of the removed mass. A whole-body examination was conducted to determine if the lesion was primary or metastatic, and the results indicated it was primary lesion. There was no evidence of other malignant lesions, and a 21-month follow-up is currently being conducted in case of recurrence. CONCLUSIONS: Primary mucinous adenocarcinoma occuring on an eyelids is a very rare malignant tumor. Complete mass removal is well known to be the best treatment. For differential diagnosis, various examinations of the entire body are required in case the lesion had metastasized from the breast, gastrointestinal tract, kidneys, ovaries, lacrimal glands and so on. Periodical postoperative examinations must be thoroughly performed, since the probability of recurrence is about 30%.