Does choroidal melanoma regression correlate with chromosome 3 loss after ruthenium brachytherapy?

AIM: To determine the reduction of choroidal melanoma thickness 6 months after ruthenium 106-brachytherapy according to chromosome 3 status, which correlates strongly with metastatic death. METHODS: Transscleral fine needle aspiration biopsy was performed prior to the insertion of a radioactive plaque if the tumour was deemed sufficiently thick and anterior for such a procedure. Transretinal biopsy with a 25-gauge vitreous cutter was performed for thin and posterior tumour within a month of plaque removal. The chromosome 3 status was determined by fluorescence in situ hybridisation from 2002 until 2006, and by either multiplex ligation-dependent probe amplification and/or microsatellite analysis after this period until the end of the study. The choroidal melanoma dimensions were obtained from outpatient visits. RESULTS: 149 eyes from 149 patients were included. The mean age was 60.8 years. 84 eyes (56.4%) had disomy 3 and 65 eyes (43.6%) monosomy 3. The median pretreatment tumour thickness was 3.0 mm in disomy 3 and 4.1 mm in monosomy 3 tumours (p=0.018). The follow-up duration medians were 6.3 months for disomy 3 and 6.4 months for monosomy 3 tumours (p=0.68). The rates of thickness reduction were 6.7% and 7.0% per month, respectively (p=0.59). Thickness reduction exceeding 50% occurred in 32 (38.1%) disomy 3 and 24 (36.9%) monosomy 3 tumours. CONCLUSIONS: The rate of choroidal melanoma regression after ruthenium-106 brachytherapy does not appear to correlate with chromosome 3 loss, suggesting that tumour thickness reduction 6 months after treatment is unlikely to predict survival.

A case of misconstrue proptosis.

This case illustrates an overlooked metastatic lung carcinoma to the orbit. The rapid onset of symptoms and oedema mimicked a cellulitis. The patient was initially treated with a broad-spectrum topical and intravenous antibiotic therapy. The white blood cell count (WBC) and C reactive protein (CRP) were normal. Compressive optic neuropathy and serous retinal detachment ensued. The initial chest x-ray revealed lung shadows; however, this was not reviewed. Eventually, CT of the chest was organised and showed a lung mass. The management of such a case remains a challenge for the uninitiated, and high index of suspicion is required to ensure early appropriate management. Despite complete resolution of the swelling with sequential chemotherapy (cisplatin and etoposide) and radiotherapy, the visual prognosis remained grim.

Elephantoid eyelid edema associated with continuous positive airway pressure treatment.

A man with rosacea developed bilateral eyelid edema from wearing a continuous positive airway pressure nasal mask daily. The edema was refractory to steroid, diuretics, and lymphatic drainage massage. The effect may be related to cumulative venous congestion and lymphostasis due to the continuous positive airway pressure treatment.

Topical beta-blocker treatment for migraine.

Beta-blockers are a well-known prophylactic treatment for migraine; however, treatment by the ocular route has not been widely considered. This case illustrates the resolution of a visual field defect associated with migraine and improvement of symptoms possibly due to administration of a topical beta-blocker. This novel method of treatment especially when visual field defects are present may have a place in the management of migraine.

Functional vision with bilateral ReZoom and ReSTOR intraocular lenses 6 months after cataract surgery.

PURPOSE: To compare the visual outcomes in patients with bilateral implantation of AcrySof ReSTOR multifocal intraocular lenses (IOLs) (Alcon Laboratories) or ReZoom multifocal IOLs (Advanced Medical Optics) 6 months after cataract surgery. SETTING: Orsett and Southend Hospital, Essex, United Kingdom. METHODS: This study comprised patients who had uneventful bilateral cataract extraction with implantation of ReZoom (n = 50) or ReSTOR (n = 50) multifocal IOLs. Parameters analyzed included binocular uncorrected distance, intermediate, and near acuities; spectacle independence; subjective visual symptoms; and patient satisfaction. All parameters were evaluated 6 months after second-eye surgery. RESULTS: All patients had binocular uncorrected distance visual acuity of 20/32 or better; there was no statistically significant difference between the 2 groups. The mean binocular uncorrected near acuity was 20/26 (J1.22) in the ReSTOR group and 20/34 (J2.34) in the ReZoom group (P<.0001). The mean binocular uncorrected intermediate visual acuity was 20/42 and 20/34, respectively (P = .003). Patients in the ReZoom group reported greater satisfaction with intermediate vision (P = .04). No statistically significant difference was found in satisfaction with near vision. Eighty-six percent of ReSTOR patients and 70% of ReZoom patients did not wear glasses for daily activities; the overall satisfaction was not statistically significantly different between groups. There was no significant difference between groups in photic phenomena. CONCLUSIONS: The ReSTOR IOL provided better near vision and the ReZoom IOL better intermediate vision. Both multifocal IOLs gave excellent distance vision. Photic phenomena were comparable and clinically acceptable. ReSTOR patients had greater spectacle independence for near vision and ReZoom patients for intermediate vision. Overall spectacle independence was not statistically significantly different.

ReSTOR intraocular lens implantation in cataract surgery: quality of vision.

PURPOSE: To compare the visual outcome and subjective visual symptoms in patients who had implantation of the AcrySof ReSTOR multifocal intraocular lens (IOL) (Alcon Laboratories) with those in patients who received the AcrySof SA60AT monofocal IOL (Alcon Laboratories) in cataract surgery. SETTING: Southend Hospital, Essex, United Kingdom. METHODS: Eighty eyes of 40 patients received the ReSTOR multifocal IOL after cataract extraction. They were closely paired in age, sex, and ocular findings with patients who had monofocal IOL implantation during the same period. The distance and near visual acuities were compared, and patient satisfaction with their vision, visual symptoms, and spectacle dependence was assessed using a standardized questionnaire. RESULTS: There was no significant difference in the mean uncorrected and best corrected distance visual acuities between the groups. An uncorrected distance visual acuity of 20/30 or better was achieved in 93.8% eyes in the multifocal group and 82.5% in the monofocal group and of 20/20 or better in 57.5% and 40.0%, respectively (P = .18). Uncorrected near visual acuity was 20/30 or better in 75.0% of eyes in the multifocal group and 3.8% in the monofocal group. Reading glasses were required by 2.5% in the multifocal group and by 92.5% in the monofocal group. Satisfactory uncorrected intermediate distance vision was achieved in 75.0% of eyes in the multifocal group and 87.5% in the monofocal group (P = .089); 85.0% of patients in the multifocal group and 7.5% in the monofocal group never had to wear glasses. Moderate glare was reported by 21.3% in the multifocal group and 7.5% in the monofocal group (P = .008); no patient reported severe glare. In the multifocal group, severe halos and moderate halos occurred in 3.8% [corrected] of eyes and 16.3% [corrected] of eyes, respectively. CONCLUSIONS: The AcrySof ReSTOR IOL provided predictably good uncorrected distance and uncorrected near acuities. Spectacle independence was significantly higher with this multifocal IOL, which outweighed the photic symptoms it caused.