Review of Targeted Therapy, Vismodegib, for the Treatment of Periocular Basal Cell Carcinoma.

PURPOSE: Periocular locally advanced basal cell carcinoma (POLA-BCC) is characterized by orbital involvement and/or extensive invasion of periocular structures. Hedgehog pathway inhibitors have been used for POLA-BCC with promising outcomes. METHODS: The authors reviewed 11 articles published in English literature from January 2012 to July 2022 and reported the outcomes of patients with POLA-BCC who were treated with vismodegib. RESULTS: A total of 384 patients were treated with vismodegib. The mean age was 72 years, and the median treatment duration was 9 months. The overall response rate was 75% with a median follow-up time of 14.4 months. Following vismodegib treatment, the median number of patients who required adjuvant surgery was 43% with a median time to surgery of 6.5 months. The exenteration rate was 6% (overall 8 patients). In total 93.7% of patients experienced grade I adverse events, 26.7% to 37.5% grade II, 8.8% to 10% grade III-IV, and 0.8% to 4.8% grade V. Major side effects included dysgeusia (30-100%), muscle spasm (15-100%), alopecia (47-75%), weight loss (23-83%), and decreased appetite (19-42%). The median percentage of patients who discontinued treatment due to toxicity was 29% with a median interval of 5 months before the development of side effects. The median recurrence rate following discontinuation of vismodegib was 7.8% with a median recurrence duration of 20 months. CONCLUSIONS: In patients with POLA-BCC, vismodegib, a hedgehog pathway inhibitor, provided high rates of orbital preservation, reducing exenteration rates to 6%. Neoadjuvant therapy with vismodegib can also be suggested for patients with POLA-BCC. While extremely effective, side effects lead to temporary or permanent discontinuation of vismodegib in small numbers of patients.

Ciliary Sulcus Implantation of Ahmed Glaucoma Valve in Patients with Corneal Decompensation Risk.

OBJECTIVES: The goal of this study was to examine the safety and efficacy of ciliary sulcus implantation of the Ahmed glaucoma valve (AGV; New World Medical, Inc., Rancho Cucamonga, CA, USA) in patients with a risk of corneal decompensation. METHODS: Patients with a corneal decompensation risk who underwent AGV implantation at a single institution were included in this retrospective study. The patients' preoperative intraocular pressure (IOP), best corrected visual acuity (BCVA), and the number of anti-glaucomatous eye drop medications used was compared with postoperative values. The success criteria were defined as a postoperative IOP of 5 to 21 mmHg and no loss of light perception. RESULTS: Twenty-three eyes of 23 (16 male, 7 female) patients were included in the study. The mean age of the patients was 64.6±14.6 years and the mean follow-up period was 15.8±8.3 months. The preoperative mean IOP was reduced from 33.6±9.1 mmHg to 16.9±5.1 mmHg at the last follow-up (p=0.000). The mean preoperative number of anti-glaucomatous eye drop medications used was 3.5±1.3. Postoperatively the mean was 1.7±1.4 at the last follow-up (p=0.000). The rate of total success was determined to be 78%. The postoperative mean BCVA did not change significantly. One patient lost light perception. A decrease in corneal clarity was observed in only 1 patient (4.3%). The postoperative complications observed were: bleb encapsulation (43%), hyphema (39%), tube occlusion (13%), choroidal detachment (8.7%), decompression retinopathy (8.7%), and corneal decompensation (4.3%). CONCLUSION: Ciliary sulcus implantation of an AGV was effective, both in terms of IOP and the decrease in anti-glaucomatous drug use in the short term. This technique may be a good choice in patients with a corneal decompensation risk due to the posterior chamber implantation.