ABSTRACT
PURPOSE: To evaluate the efficacy of botulinum toxin injection in the patients with type 1 Duane syndrome and identify the predictive factors for success. METHODS: Sixteen patients with esotropic type 1 Duane syndrome without history of ocular surgery were selected for this interventional case series. The botulinum toxin was injected in the medial rectus of all patients. Visual acuity, dry refraction, cyclo-refraction, ocular motility, and amount of deviation were measured. Complete success, partial success, and failure were defined as residual deviation/face turn less than 8 prism diopters (PD)/5°, 8-20 PD/5-15°, and equal or greater than 20 PD/15°, respectively. RESULTS: Sixteen cases (6 males) were included in our study. The mean esotropia was 26.27 ± 8.35 (12-40 PD) which was reduced significantly to 13.5 ± 12.39 PD during 6 months follow-up (p < 0.001). Face turn was improved significantly from a preoperative mean of 18.27° to: 0.094° at 1 week, 0.11° at 1 month, 3.31° at 3 months, and 7° at 6 months (p < 0.001). Complete success was seen in 6 patients (37.5%), partial success in 4 patients (25%), and failure in 6 patients (37.5%). There was a significant relation between the amount of forced duction testing (FDT) and the success rate (p: 0.019). No complication was seen during injections. CONCLUSIONS: Botulinum toxin could be an alternative treatment in Duane syndrome with appropriate case selection. FDT could be a predictive factor for response to botulinum toxin.
ABSTRACT
PURPOSE: To discuss the clinical characteristics, treatment and outcomes of germline and non-germline retinoblastoma tumors. METHODS: A retrospective study was performed on retinoblastoma cases from 1979 to 2007. General characteristics of the patients, treatment modalities, histopathological findings and survival were compared in germline versus non-germline cases. RESULTS: We analyzed 557 cases of retinoblastoma with mean age of 32.2±22.0 months including 177 and 380 patients with germline and non-germline tumors, respectively. Germline cases were significantly different from non-germline counterparts in terms of mean age (24.7±17.7 vs 35.7±23.0 months), symptoms (leukocoria in 49.4% vs 62.9%), and outcomes (death in 40.1% vs 13.9%), respectively (P<0.001). In the germline group 66.5% and in non-germline group over 97% of patients had stage Va or higher (ICRB D-E disease). Disease-free survival was 48.6% for germlines cases versus 80.9% for non-germline patients (with mean follow up of 61.9 months, P<0.001). Histopathologically, more invasions to intraocular and extraocular tissues were seen with non-germline tumors of (66% vs 39.8%). Mortality rates in germline cases and non-germline were 40.1% and 13.9%, respectively (P<0.001). CONCLUSION: Despite higher tumor staging in nongermline cases at the time of diagnosis and therefore more aggressive behavior of the tumor, germline cases had a higher rate of mortality during the follow up period.
ABSTRACT
PURPOSE: To increase sensitivity of impression cytology (IC) for the diagnosis of conjunctival intraepithelial neoplasia (CIN) by three repeated applications of IC. METHODS: This study included 35 eyes with a clinical diagnosis of CIN and 6 eyes with pinguecula as control. All eyes received IC by three consecutive applications of the cellulose acetate filter paper. All eyes in the CIN group had subsequent surgical excision with histopathological evaluation. The sensitivity of each application of IC for the diagnosis of CIN was determined. RESULTS: In the control group, all IC specimens were negative for CIN. In the CIN group, with positive histopathology in all cases, the first IC was positive in 17 eyes (56.7%), showed atypical squamous cells indefinite for dysplasia (ASCID) in 8 (26.7%) and was negative in 5 (16.6%). The second application was positive in 25 eyes (83.3%), showed ASCID in 3 (10%) and was negative in 2 (6.7%). The third application was positive in 26 eyes (87.7%), showed ASCID in 3 (10%) and was negative in 1 (3.3%). The second application resulted in a statistically significant higher positive yield than the first application (p=0.009), with no significant difference between the second and the third applications (p=0.12). CONCLUSION: Consecutive repeated applications of filter paper significantly increased the diagnostic sensitivity of IC for the diagnosis of CIN.
