ABSTRACT
Reconstruction of a large defect after the removal of a massive malignant upper lid tumor is still a challenge in oculoplastic surgery. Our method of choice is Mustardé switch flap. Due to the lack of Mohs micrographic surgery and frozen section technique as well as waiting time of two weeks for histopathological results, we made modifications enabling us to reexcise in case of positive margins: the width of the pedicle of the flap was 7 mm allowing the length of the flap to be increased if needed, the lids were closed with temporary lateral tarsorrhaphy to protect the eye, and the lower lid is finally reconstructed in the second stage of the procedure. In three patients with malignant upper lid tumors, this method of reconstruction proved to be safe and effective with favorable long-term results.
ABSTRACT
INTRODUCTION: Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). OBJECTIVE: Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. METHODS: This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (D) and the largest basal dimension (B) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial D and B values. RESULTS: The study involved 10 patients with a mean age of 64.4 years (yr) (range 46-80 yr). D ranged from 1.82 to 5.5 mm (median 2.99 mm) and B from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for D was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for B it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. CONCLUSION: The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.
ABSTRACT
This is the first documentation of vancomycin precipitation with viscoelastic in the anterior chamber of the eye. A 34-year-old white male underwent uneventful penetrating keratoplasty. Intracameral instillation of 1 mg/0.1 mL of vancomycin followed no attempts of meticulous viscoelastic irrigation. Six hours later thick white material in the anterior chamber was sedimented. The following criteria excluded the diagnosis of endophthalmitis and TASS: clear and transparent anterior chamber and vitreous body, the absence of ciliary injection and corneal oedema, and unremarkable laboratory tests' results. This iatrogenic complication mimicking endophthalmitis does not require any specific management and should be acknowledged in guidelines for prevention and treatment of endophthalmitis. The objective of this paper is to alert colleagues to this iatrogenic complication of vancomycin mimicking endophthalmitis. Whether this condition should be labelled as positive or negative demands further investigation. As vancomycin is a time-dependent antibiotic, it is possible that this precipitate could serve as a slowly releasing drug depot and viscoelastic as a vehicle for precipitation. This being the case, investigation is needed to analyse its potential to precipitate with another dispersive and cohesive viscoelasticity.
