Carboplatin loaded polymethylmethacrylate nano-particles in an adjunctive role in retinoblastoma: An animal trial.

Purpose: The purpose of the study is to compare the intra-vitreal concentrations of carboplatin, post peri-ocular injections of commercially available carboplatin (CAC) and a novel carboplatin loaded polymethylmethacrylate nanoparticulate carboplatin (NPC), in either eye, as a model system for treatment of advanced intra-ocular retinoblastoma (RB). Design: Experimental, comparative, animal study. Materials and Methods: Polymethylmethacrylate nanoparticles were prepared by free radical emulsion polymerization of methyl methacrylate in aqueous solution of carboplatin in the presence of surfactant sodium dodecyl sulfate and thermal initiator ammonium persulfate. 21 Sprague-Dawley rats, aged between 6 weeks and 3 months were enrolled. The right eye of each rat was injected peri-ocularly with CAC formulation (1 ml of 10 mg/ml) and the left eye with NPC (1 ml of 10 mg/ml), post-anesthesia, by an ophthalmologist trained in ocular oncology. Three rats each were euthanized on days 1, 3, 5, 7, 14, 28 and 42, post-injection and both eyes were carefully enucleated. Intra-vitreal concentrations of CAC and NPC were determined with Inductively Coupled Plasma Atomic Emission Spectroscopy. Analysis of data was done with paired t-test. Results: The intra-vitreal concentration of carboplatin with NPC was ~3-4 times higher than with CAC in all animals, on all the days (P < 0.05). Conclusion: A higher trans-scleral permeability gradient is obtained with the novel nanoparticles than with the commercial drug, leading to sustained higher levels of carboplatin in the vitreous. Peri-ocular injection of NPC could thus have an adjuvant effi cacy in the treatment for advanced clinical RB, specifi cally those with vitreous seeds.

Periocular necrotizing fasciitis associated with kerato-conjunctivitis and treated with medical management: a case report.

We report a 25-year-old systemically healthy male who presented with periocular necrotizing fasciitis (NF) in the left eyelid. This was associated with the presence of immunologically mediated marginal kerato-conjunctivitis, in the same eye. This potentially dangerous lid infection and the associated ocular surface infection resolved successfully, with medical management. We report this case to highlight the successful conservative management of periocular NF and the hitherto unreported anterior segment involvement.

Management of an irradiated anophthalmic socket following dermis-fat graft rejection: A case report.

Dermis-fat graft (DFG) is often the only promising option in cases of severely contracted sockets. However, there is an increased risk of graft failure in irradiated sockets with decreased vascularity. In such difficult cases, repeat DFG implantation also has higher risks of graft failure. We describe an ingenious method of successful management of an irradiated anophthalmic socket following DFG infection and necrosis, with acceptable cosmetic results. At surgery, an orbital impression was taken with ophthalmic grade alginate. Based on this measurement, a custom-made stem pressure socket-expander made up of high density polymethyl methacrylate (PMMA) was fitted, a week post surgery and kept in situ for six weeks. On review, the fornices had considerably deepened. The expander device was removed and the patient was now fitted with a custom-made thicker prosthesis made up of high-density PMMA. The patient has followed up for a year subsequently and the prosthesis has remained stable.

Systemic chemotherapy and tamoxifen induced regression of choroidal metastasis from a breast carcinoma in a male.

We report a case of a 55-year-old male patient with breast carcinoma, who developed choroidal metastasis. The patient had undergone mastectomy for carcinoma of right breast, five years ago. The patient was advised close follow-up for the left eye, as he was already on tamoxifen therapy (started a month ago) for spinal metastasis. On last follow-up, a year later, the choroidal lesion had completely scarred, with no recurrences. Systemic hormonal therapy like tamoxifen given for the breast primary and other systemic metastases may cause regression of the choroidal metastasis, thereby avoiding ocular radiotherapy. Medline search revealed only one published case of regression of choroidal metastasis from a male breast primary, on tamoxifen therapy.

The role of botulinum toxin in correcting frontalis-induced eyelid pseudo-retraction post ptosis surgery.

We report a case of a 52-year-old female patient who developed overcorrection, due to brow overuse, post surgery for bilateral aponeurotic ptosis. The patient had undergone levator palpebrae superioris plication bilaterally. Due to brow overuse habituated by long standing ptosis, the patient presented with superior scleral show, post ptosis surgery. The lid contour was normal in both eyes and when brow overaction was blocked mechanically, the palpebral fissure heights were normal, comparable, with no scleral show bilaterally. Despite repeated instructions, when the patient continued brow overuse subconsciously, an injection of botulinum toxin was given just above both brows. This led to elimination of brow overuse within a month, with elimination of superior scleral show. The patient maintained lid and brow symmetry with no overaction, eight months post injection.

Phacoemulsification and pars plana vitrectomy: a combined procedure.

AIM: To describe the results of a combined procedure including phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL) and pars plana vitrectomy (PPV) in eyes with vitreoretinal pathology and coexisting significant cataract. DESIGN: Retrospective, consecutive, noncomparative, interventional case series. MATERIALS AND METHODS: Medical records of patients who had undergone phacoemulsification, PPV and PCIOL implantation as a combined procedure between January 2000 and December 2004 were retrospectively reviewed. The main outcome measures were the anatomical success of retina, defined as reattached retina, intraoperative and postoperative complications and functional success in terms of final best corrected visual acuity. RESULTS: In all, 65 eyes of 64 patients were included. The mean age of the patients was 50.9 years +/- 17.1 (range, five to 82 years). Vitreous hemorrhage with or without retinal detachment (19 eyes, 29.2%) was the most common indication for the vitreoretinal procedure. Primary anatomical success of retina was achieved in 59 eyes (90.7%). Visual acuity improved in 48 eyes (73.8%), was unchanged in 12 eyes (18.5%) and deteriorated in five eyes (7.7%). Postoperative inflammation was significantly more in the subgroup of previously vitrectomized eyes (42%) (P =0.014, Fisher exact test) compared to those which underwent primary vitrectomy. CONCLUSIONS: Combined surgery is a feasible option for patients with vitreoretinal diseases and cataract.

Bilateral epithelial defects after laser in situ keratomileusis. Clinical features, management and outcome.

PURPOSE: To describe the preoperative characteristics, intraoperative details, management, and postoperative in patients with bilateral epithelial defects after laser in situ keratomileusis (LASIK). METHODS: Retrospective non-comparative case series. RESULTS: Six patients with bilateral epithelial defects after LASIK were part of a cohort of 605 patients undergoing bilateral LASIK at our center from December 2001 to April 2003. The mean age of the patients (5M:1F) was 28.5 +/- 7.9 years, and the average pretreatment myopic spherical equivalent (SE) refraction was 7.3 +/- 0.7 D (-4, -12.25D). An epithelial flap was present in 6 eyes and an epithelial defect with a mean diameter of 3 mm (2mm, 6mm) was seen in 6 eyes. In four patients the epithelial disturbance was bilaterally similar. All defects occurred in the inferior cornea and the epithelial flaps had the hinge positioned superiorly. None of the patients had ocular or systemic risk factors that could have resulted in this complication. A bandage contact lens was used in 6 eyes. At last follow-up of 5.5 +/- 9.5 months (0.25, 21 months), unaided visual acuity was 6/9 or better in 10 eyes. Best spectacle-corrected visual acuity (BSCVA) was maintained in 8 eyes, while 4 eyes lost one line of BSCVA. Recurrent corneal erosions were not reported in the follow-up period. CONCLUSIONS: These patients represent a hitherto unrecognised group of individuals who appear to have a subclinical weakness of adhesion of the corneal epithelium to the underlying structures, which is not evident on clinical examination. This results in bilateral epithelial disturbances after LASIK. Appropriate management results in satisfactory clinical outcomes. Other options for treatment of the fellow eye of such patients include the use of a different microkeratome, release of suction during the reverse pass of the Hansatome microkeratome, and photorefractive keratectomy if the refractive error is low.