ABSTRACT
The treatment of choice for malignant eyelid tumors is surgical excision. If this is not feasible or undesirable, a number of alternative treatments are available. Possible systemic preparations are vismodegib and sonidegib for basal cell carcinoma as well as cetuximab and cemiplimab for squamous cell carcinoma. Cryodestruction is possible for superficial tumors. In situ findings can be treated with the local preparations imiquimod or 5fluorouracil and with photodynamic therapy. An interdisciplinary cooperation with dermatologists is advisable.
Subject(s)
Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Eyelid Neoplasms , Photochemotherapy , Skin Neoplasms , Eyelid Neoplasms/therapy , Humans , Skin Neoplasms/therapyABSTRACT
Whenever funduscopy reveals possible choroidal melanoma, all available information must be gathered to either confirm or exclude the diagnosis. Well-defined funduscopic criteria are available, which can already lead to a high degree of diagnostic certainty. Additional technical examinations can be used to exclude possible differential diagnoses. In cases where no clear diagnosis can be established, it is possible to take a biopsy or to watch and wait in order to observe possible growth. Whenever the diagnosis of a choroidal melanoma is established, cancer staging has to be performed in order to search for possible metastases.
Subject(s)
Choroid Neoplasms , Melanoma , Biopsy , Choroid Neoplasms/diagnosis , Diagnosis, Differential , Humans , Melanoma/diagnosis , Neoplasm StagingABSTRACT
When Descemet membrane endothelial keratoplasty (DMEK) is indicated in patients with phakic eyes, a combination with phacoemulsification and intraocular lens implantation in one sitting should be considered as a triple DMEK. The best possible preoperative deswelling of the cornea should be strived for in order to allow sufficient viewing conditions for the individual stages of cataract surgery. Furthermore, technical details, e.g. regulation of pupillary width also must be considered. The power of the intraocular lens has to be adjusted in order to compensate for the shift of refraction towards hyperopic values induced by DMEK surgery. A rapid and clear improvement in visual acuity can normally be achieved after a triple DMEK. There seem to be no disadvantages compared with a two-stage procedure for DMEK and cataract surgery.
Subject(s)
Cataract/therapy , Combined Modality Therapy/methods , Descemet Stripping Endothelial Keratoplasty/methods , Lens Implantation, Intraocular/methods , Phacoemulsification/methods , Vision Disorders/prevention & control , Cataract/complications , Cataract/diagnosis , Evidence-Based Medicine , Humans , Monitoring, Intraoperative/methods , Treatment Outcome , Vision Disorders/diagnosis , Vision Disorders/etiology , Visual AcuityABSTRACT
BACKGROUND: A hyperopic shift, i.e. a shift of refraction in the direction of plus values, in Descemet membrane endothelial keratoplasty (DMEK) is a well-known phenomenon. Because of the need to select an appropriate intraocular lens power this becomes particularly relevant in triple DMEK, which is a combination of DMEK and cataract surgery. OBJECTIVES: In this study the refractive changes induced by triple DMEK were evaluated. The underlying mechanisms were classified based on corneal topographical data. MATERIAL AND METHODS: The study involved a retrospective evaluation of 29 eyes from 26 patients who underwent triple DMEK. The preoperative and postoperative refractions were compared with the initially desired target refraction. Calculations concerning refractive power were performed using corneal topographical data and the Gullstrand formula. RESULTS: On average a hyperopic shift was observed. The operation led to steepening of the posterior corneal surface and flattening of the anterior corneal surface. Both resulted in a reduction of corneal refractive power but changes of the posterior corneal surface were identified as the most important factor. Those patients in whom both eyes had been operated on, showed very similar postoperative topography for both eyes, irrespective of the preoperative values. CONCLUSION: The observed hyperopic shift was a mean value. A prediction of refraction in the individual cases by means of the available parameters was not possible. In general, the selection of an intraocular lens with a stronger myopic target refraction than that for standard cataract surgery is recommended.
Subject(s)
Cataract/therapy , Combined Modality Therapy/methods , Descemet Stripping Endothelial Keratoplasty/methods , Lens Implantation, Intraocular/methods , Phacoemulsification/methods , Refractive Errors/prevention & control , Aged , Cataract/complications , Cataract/diagnosis , Humans , Male , Monitoring, Intraoperative/methods , Refractive Errors/diagnosis , Refractive Errors/etiology , Retrospective Studies , Treatment Outcome , Visual AcuityABSTRACT
BACKGROUND: During unilateral treatment with ranibizumab, a reduction in the retinal thickness in the non-treated eye is occasionally observed. This may be due to the natural progression of the condition. It could also be the consequence of systemic absorption of intravitreal injections, leading to effects in the contralateral eye. PATIENTS: We describe 40 patients with either exsudative age-related macular degeneration (AMD) or diabetic macular oedema (DME). During treatment with ranibizumab, a reduction in retinal thickness in the contralateral eye was observed in this group (observation group). Another 40 AMD or diabetes patients under treatment with ranibizumab were selected as control group. These patients showed retinal swelling in the contralateral eye, which remained stable or increased. RESULTS: In the observation group, 58â% of the patients had a DME and 42â% had an AMD; in the control group, 25â% of the patients had a DME and 75â% of the patients had an AMD (p = 0.003). Retinal thickness before injection was 519 ± 126 µm in the observation group and 432 ± 87 µm in the control group (p = 0.003). Retinal thickness in the contralateral eye was then 511 ± 162 µm in the observation group and 436 ± 149 µm in the control group (p = 0.036). The reduction in retinal thickness in the injected eye was 214 ± 144 µm in the observation group and 150 ± 89 µm in the control group (p = 0.06). CONCLUSION: In the group of patients that showed reduction in retinal thickness under ranibizumab in the contralateral eye, there were more diabetes patients than in the comparable control group. Even before injection, these patients showed higher retinal thickness in both eyes than did those in the control group. Further prospective studies would be required to confirm a possible causal connection between ranibizumab injection and reduction in DME in the contralateral eye.
