Paediatric glaucoma in Scotland.

BACKGROUND: The primary aim was to estimate the incidence of primary and secondary childhood glaucoma in Scotland over a 2-year period. The secondary aim was to gauge the confidence and experience of ophthalmologists in Scotland in managing these patients. METHODS: A 7 question electronic survey was distributed to all consultant members of the Scottish Paediatric Club and Scottish Glaucoma Club. Respondents were asked to report the number of cases and types of childhood glaucoma they had managed in the last 2 years. Respondents were also asked about experience and confidence in a range of glaucoma procedures, number of patients requiring referral to specialist centres and interest in the development of a centre of excellence in Scotland. RESULTS: The survey returned a 56% response rate, reporting 85 new cases of paediatric glaucoma in Scotland over the preceding 2 years. 11 (12.9%) had primary glaucoma and 74 (87.1%) had secondary glaucoma. The most common subtype of secondary glaucoma was uveitic glaucoma (n = 29). None of the respondents declared confidence or experience in trabeculotomy or goniotomy procedures. Eleven children required referral to a specialist unit outside Scotland. 85.7% of respondents felt Scotland would benefit from a specialist unit for paediatric glaucoma. CONCLUSIONS: This survey reflects an appetite for a specialist service for paediatric glaucoma in Scotland. However, further consideration is needed to determine if there is sufficient patient load to maintain such a service.

Diplopia and variable ptosis as the sole initial findings in a case of orbital plasmacytoma and multiple myeloma.

Plasmacytomas are monoclonal plasma cell tumors. They represent 3% of all orbital tumors. We present an unusual case of orbital plasmacytoma and advanced multiple myeloma where the sole presenting symptoms were those of diplopia and ptosis. Clinical examination revealed right hypertropia and variable left upper lid ptosis but no proptosis. The visual acuity and the rest of the ocular examination were normal in both eyes. An MRI scan of the brain and orbits revealed a frontal bone lesion consistent with a plasmacytoma. A bone marrow biopsy showed a light chain multiple myeloma with free lambda light chains. Although the literature reports diplopia and ptosis as being clinical features of orbital plasmacytomas, to our knowledge this is the first reported case where these symptoms were the only presenting features, despite widespread disease.

Presumed occult globe rupture resulting in sympathetic ophthalmia.

INTRODUCTION: Sympathetic ophthalmia (SO) is an uncommon bilateral granulomatous panuveitis following uveal trauma to one eye. We present an unusual case of SO which resulted from presumed occult globe rupture following blunt trauma; and highlight the association of trauma and acquired external ocular pigmentation as a possible predictor for SO. CASE REPORT: Five weeks following blunt trauma to the left eye (OS), a 30-year-old patient presented complaining of spontaneous blurred vision (4/60) in the right eye (OD). In the OD, there was anterior chamber and vitreous inflammation (3+), multiple areas of serous retinal detachments, Dalen Fuchs spots, and optic disk swelling. In the OS, there was iridodialysis, post-traumatic acquired external ocular pigmentation suggestive of occult globe rupture. This was diagnosed as SO and treated with systemic steroids and a steroid sparing agent; which resulted in resolution of the inflammation with improvement in the visual acuity. CONCLUSION: Sympathetic ophthalmia has been reported to occur following penetrating eye injury secondary to trauma and surgery, and also secondary to non-penetrating eye trauma. This case reports SO occurring after presumed occult globe rupture; and reinforces the association between acquired external ocular pigmentation and SO in the context of trauma.

Melanoma maligno: medidas de confort. A propósito de un caso / No disponible

Describimos el caso de una paciente afectada por un melanoma léntigo maligno en estadio IV en pie derecho y progresión en múltiples lesiones. Presentaba sangrado a la realización de las curas y un olor nauseabundo que le impedía poder estar en el domicilio familiar e incluso que sus nietos se acercaran a ella, lo cual era una de sus mayores preocupaciones. Existen numerosas técnicas que son utilizadas para la realización de curas de lesiones tumorales; nosotros optamos por la utilización de gel demetronidazol 1% y lidocaína 2% (fórmula magistral) para controlar el mal olor y el dolor, ácido aminocaproico para el sangrado y la administración de analgésicos previamente a la realización de la cura para tratamiento del dolor incidental. Con estas medidas se contribuyó a la disminución del olor y del dolor teniendo siempre en cuenta más el cuidar que el curar. Evidenciamos el aumento la calidad de vida percibida por la paciente, facilitando así el fallecimiento en el domicilio familiar (AU)

We describe the case of a female patient affected by stage-IV lentigo malignant melanoma in the right foot with progression to multiple injuries. She had bleeding during wound care, and a nauseating odor that prevented her family, even her grandchildren from approaching her, which was one of her biggest concerns. Many techniques may be used for wound care, and we opted for 1% metronidazole gel and 2% lidocaine to manage odor and pain, aminocaproic acid for bleeding, and pain killers prior to wound care and dressing procedures in order to prevent breakthrough pain. These measures contributed to a decrease in odor and pain. Patient-perceived quality of life increased, and the dying process at home was optimized (AU)

Foveal anatomic associations with the secondary peak and the slope of the macular pigment spatial profile.

PURPOSE: To investigate the reproducibility of the macular pigment (MP) spatial profile by using heterochromatic flicker photometry (HFP) and to relate the MP spatial profile to foveal architecture. METHODS: Sixteen healthy subjects (nine had the typical exponential MP spatial profile [group 1]; seven had a secondary peak MP spatial profile [group 2]) were recruited. The MP spatial profile was measured on three separate occasions. Six radiance measurements were obtained at each locus (0.25 degrees , 0.5 degrees , 1 degrees , and 1.75 degrees eccentricity; reference point, 7 degrees ). Foveal architecture was assessed by optical coherence tomography (OCT). RESULTS: Subjects who had the typical decline profile, had this profile after averaging repeated measures (group 1). Subjects who had a secondary peak, displayed the secondary peak after repeated measures were averaged (group 2). Mean SD foveal width in group 1 was significantly narrower than mean SD foveal width in group 2 (1306 +/- 240 microm and 1915 +/- 161 microm, respectively; P < 0.01). This difference remained after adjustment for sex (P < 0.001). Foveal width was significantly related to mean foveal MP, with adjustment for sex (r = 0.588, P = 0.021). Foveal profile slope was significantly related to MP spatial profile slope, after removal of an outlier (r = 0.591, P = 0.020). CONCLUSIONS: HFP reproducibly measures MP spatial profile. Secondary peaks seen in the MP spatial profile cannot be attributed to measurement error and are associated with wider foveas. The slope of an individual's MP spatial profile is related to foveal slope, with a steeper MP distribution associated with a steeper foveal depression.

Osteonecrosis maxilar asociada a bifosfonatos. A propósito de un caso / No disponible

Los bifosfonatos son potentes inhibidores de la actividad osteoclástica acumulándose en la matriz ósea durante largos periodos de tiempo. Los bifosfonatos intravenosos como el pamidronato y el ácido zoledrónico son usados ampliamente en el paciente oncológico para el tratamiento de la hipercalcemia tumoral, mieloma múltiple, metástasis óseas de tumores sólidos (mama, próstata y pulmón) y para la prevención de metástasis óseas en tumores de mama y próstata. Recientemente se ha descrito la aparición de osteonecrosis maxilar asociada a bifosfonatos que representa una seria complicación clínica en pacientes con cáncer. Existen factores comórbidos cuyo papel aún está por determinar: corticoides, mal estado cavidad oral, procedimientos dentales, etc. Las lesiones son de difícil tratamiento por lo que, actualmente la prevención es el mejor enfoque terapéutico.Describimos el caso de una paciente afectada de cáncer de mama con metástasis óseas en tratamiento con ácido zoledrónico y que presentó osteonecrosis mandibular (AU)

Bisphosphonates are potent inhibitors of osteoclastic activity, and accumulate over an extended period of time in the mineralized bone matrix. Intravenous bisphosphonates (pamidronate and zoledronic acid) are widely used to treat malignancy-related hypercalcemia and multiple myeloma, for the treatment of patients with documented bone metastases from solid tumors (breast, prostate, lung), and for the prevention of bone metastases from breast or prostate carcinoma. Recently, bisphosphonate-associated osteonecrosis of the maxillaries has been described, and represents a serious clinical complication in cancer patients. Comorbid factors such as concomitant use of corticosteroids, oral pathology, poor oral hygiene, and dental procedures may also play a role. The management of these lesions is difficult, and hence preventive measures are of paramount importance. We report a case of maxillary osteonecrosis in a patient with breast cancer and bone metastases treated with zoledronic acid (AU)