Efficacy of vincristine and carboplatin as chemo-reduction for advanced bilateral retinoblastoma, the Saudi experience

To evaluate the efficacy of a 2-drug chemotherapy regimen without external-beam radiotherapy [EBRT] and/or without enucleation in bilateral retinoblastoma. From 1996 to 2010, 79 patients were diagnosed with bilateral RB and were eligible for chemotherapy. Chemotherapy was administered prior to and/or following local therapy to the eye. All patients received 3 cycles of chemo-reduction with carboplatin and vincristine, additional cycles of the same or other chemotherapy, local therapy, EBRT and enucleation were determined according to re-evaluation by the ophthalmologist. Advanced disease was seen in 115 [79%] eyes [group IV and V: 96, Group D and E: 19] out of 146 affected eyes. Tumor response after chemotherapy was observed in 78 patients [98.7%]; complete response in 25 [32.1%], partial response in 49 [62.8%] Four [5.1%] had progressive disease. A total of 50 [63.3%] patients required EBRT; 38 for persistent disease, 4 for progressive disease, 2 for new lesions, 2 for re-activation and 4 for disease control. Enucleation was required in 15 [19%]. Secondary malignancies occurred in two patients who underwent EBRT; one osteogenic sarcoma and one rhabdomyosarcoma then later osteogenic sarcoma. The 10 year overall survival was 96.3% with a median follow-up time of 3.124 +/- 0.536 years [95%CI: 2.074-4.174]. The 2-drug chemotherapy regimen combined with local therapy appears to be adequate therapy for low stage disease but not in patients with advanced disease. The occurrence of secondary cancers in this group of patients is worrisome further highlighting the deleterious effects of EBRT

Iris melanocytoma in child diagnosed by fine needle aspiration Biopsy

We report a case of large iris melanocytoma in a child diagnosed by fine needle aspiration biopsy. In this interventional case report, cytologic features typical of melanocytoma were obtained by fine needle aspiration biopsy [FNAB]. FNAB can be used in difficult diagnostic cases if a good sample is obtained, this technique has an accuracy of more than 99% in tumors larger than 3 mm; however, false-negative and false-positive results may be obtained. Its risk of local spread is very small, an advantage over incisional biopsy. The most common complication is intralesional hemorrhage and hyphema.

Successful removal of a conjunctival myxoma

A 45-year-old woman presented with conjunctival myxoma in the right eye. A mixture of healon and trypan blue solution 0.06 mg was injected through a 27-gauge needle into the conjunctiva to delineate the lesion to achieve complete removal. This technique is effective in delineating the myxoma while preserving its integrity during removal. It may also help in lowering recurrence

Histopathological findings of failed grafts following Descemet's stripping automated endothelial keratoplasty [DSAEK]

To study the histopathological findings of the early cases of failed DSAEK grafts and to analyze the causes of graft failure. Retrospective study of 13 failed DSAEK grafts [four grafts submitted alone with no host cornea] of 12 patients. The histopathologic features are correlated with the clinical and operative findings. Significant attenuation of the endothelial cells found in 10/13 cases [77%], retained recipient Descemet's membrane in 7/13 [54%], variability of graft thickness in 5/13 [38%] and two of these had stromal irregularity. Retrocorneal fibrous membrane along the donor's Descemet's membrane was found in 4/13 [31%] resulting in endothelial detachment in one case. Eight of the nine host cornea-graft specimens were found to have: total graft-cornea detachment [in one], subtotal in four and partial [

Orbital alveolar soft part sarcoma: histopathologic report of two cases

Alveolar soft part sarcoma is considered as a distinct histopathological entity with rare cases reported from the orbit area. Two cases of alveolar soft part sarcomas occurring in the orbit of two patients along with their histopathologic findings are reported herewith. In both cases, the patients presented with eyelid swelling and proptosis. The diagnosis was made by incisional biopsies and histopathology. The literature is reviewed regarding occurrence of this tumor, its diagnosis and management