T-cell lymphoblastic lymphoma involving the ocular adnexa: report of two cases and review of the current literature.

The majority of ocular adnexal lymphomas are B-cell in origin. We report two cases of T-cell lymphoblastic lymphoma (T-LBL) involving the ocular adnexa. One patient presented with a painless pink conjunctival lesion and inferior orbital fullness. The second patient presented with a painless orbital mass. The diagnoses were confirmed by histopathology and immunohistochemistry. Both patients had extensive multifocal lesions during staging. Prompt intensified chemotherapy regimens were initiated. T-LBL is an aggressive disease with poor prognosis. This report emphasizes the importance of timely diagnosis by the ophthalmologist with co-management and treatment with an oncologist.

Ranibizumab versus mitomycin C in primary trabeculectomy--a pilot study.

PURPOSE: The current standard adjunctive agent used in primary trabeculectomy is mitomycin C (MMC), but it is associated with well known complications. The objective of this study is to test the feasibility of the anti-vascular endothelial growth factor (anti-VEGF) agent ranibizumab for adjunctive use instead of MMC (0.4 mg/ml). MATERIALS AND METHODS: A prospective, randomized open label study of 24 consecutive patients undergoing primary trabeculectomy at the Wills Eye Institute Glaucoma Service from March 2008 through February 2010 was conducted. Twenty-four eyes were included in the study and clinical outcomes were examined. RESULTS: There were no significant differences in baseline demographic or clinical characteristics between the ranibizumab and MMC groups. Nine of the 12 ranibizumab patients completed the 1 year study. Three subjects required tube shunt surgery and were removed from the study. Eleven of 12 MMC patients completed the study (one underwent hip surgery and was lost to follow-up). Mean intra-ocular pressure (IOP) was significantly higher in the ranibizumab arm at 1 month (p = 0.002). Bleb extent was significantly less in the ranibizumab arm at 6 months (p = 0.006). Patients in the ranibizumab arm required more hypotensive medication at month 3 (p = 0.011). CONCLUSIONS: Although there was no IOP difference or difference in medication use between the two treatment groups at one year, more patients in the ranibizumab group required additional glaucoma surgery during the study period.

Intracameral triamcinolone acetonide in glaucoma surgery: a prospective randomized controlled trial.

PURPOSE: To evaluate the efficacy and safety of intracameral triamcinolone acetonide (TA) in glaucoma surgery. DESIGN: Prospective randomized clinical trial. SETTING: Institutional-Wills Eye Hospital. STUDY POPULATION: Patients undergoing trabeculectomy (with or without cataract surgery) or tube shunt surgery. INTERVENTION: Patients were randomized to receive intracameral TA or balanced salt solution at the end of surgery. Follow-up time was 6 months. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, inflammation measured by slit-lamp examination and laser flare meter, cataract grading, bleb appearance, dry eye scores, use of supplemental medical therapy, surgical success, and rate of complications. RESULTS: Seventy-seven patients were enrolled in the study, including 37 in the TA group and 40 in the control group. There were no significant differences in success rates between the 2 groups (P=.60). Intraocular pressure and medication use were similar between the groups for each follow-up visit. Dry eye scores were lower in the TA group at month 1 (P=.042), while flare scores were higher in the TA group on day 1 (P=.015) but lower at month 1 (P=.044). The complication rates were higher in the TA group on day 1 (P=.04). All other outcome measures were similar for both groups. CONCLUSIONS: Intracameral TA did not affect the success rates or change the complication rates of glaucoma surgery.

ExPRESS shunt surgery: preferred glaucoma surgery in residency training?

It is important to equip future ophthalmic surgeons with appropriate surgical skills without compromising patient care. The ExPRESS implant surgery is very similar to trabeculectomy surgery in both efficacy and technique, but is less traumatic and may be prone to less postoperative hypotony and require less postoperative hypotensive medications. although affording a way to teach a novice surgeon the steps and technique of trabeculectomy and minimizing patient risk, ExPRESS implantation is a more expensive surgery that involves placing a foreign body in the eye. Further, needling an ExPRESS is a more technically challenging procedure than needling a trabeculectomy and more limited in its scope.