[Inveterate squamous cell carcinoma of the upper eyelid: a case report]. / Carcinoma squamocellulare inveterato della palpebra superiore: Caso clinico.

Squamous cell carcinoma (SCC) is a malignant tumor of epithelium that shows squamous cell differentiation. It is the second most common cancer of the skin and usually occurs in areas exposed to the sun but it can rarely arise within the conjunctival epithelium with a deep component. We describe a woman with a history of chronic blepharoconjunctivitis unresponsive to topical medications. Examination disclosed a hyperaemic translucent patch with blurred margins of the upper palpebral conjunctiva. Tarsoconjunctival biopsy revealed intraepithelial squamous cell carcinoma. Management consisted of complete tumor excision with removal of the entire posterior lamella of the left upper eyelid and reconstruction. Histopathologic analysis confirmed primary squamous cell carcinoma arising from conjunctival epithelium, involving the underlying tarsus. Patients with unexplained chronic unilateral blepharoconjunctivitis or papillary hypertrophy of the palpebral conjunctiva should be considered for biopsy to rule out neoplasia, even when there is no sign of an evident mass.

Standard automated perimetry and algorithms for monitoring glaucoma progression.

Despite increasingly sophisticated techniques for the computerized analysis of the optic nerve and retinal nerve fiber layer, standard automated perimetry (SAP) is still the primary test for assessing functional damage in glaucoma. Most of the diseases affecting the visual field can be studied analyzing the central visual field with a fixed grid of points set at 6 degrees or at a variable density within central 30 degrees, using a III white target stimulus (program 30/2 or 24/2 Humphrey, G1/G2 or 30/2 Octopus). Although there is lack of a true gold standard for glaucoma, SAP results were the primary endpoint in most of the clinical trials in glaucoma. New thresholding strategies allowed a considerable reduction of examination time without substantial loss of accuracy. Moreover, recent findings on structure-function correlation in glaucoma validate the clinical role of this well-known and widespread method of examination.

Laser therapies for glaucoma: new frontiers.

Glaucoma is a long-term ocular neuropathy defined by optic disc or retinal nerve fiber structural abnormalities and visual-field defects. Treatment for glaucoma consists of reducing intraocular pressure (IOP) to an acceptable target range to prevent further optic-nerve damage. Currently available treatments include topical drug (single then multidrug combinations) followed, for those patients on maximal tolerated medical therapy who still need additional IOP reduction, by laser treatments. These included laser iridotomy, laser trabeculoplasty, laser iridoplasty, laser cyclophotocoagulation. Although the various types of laser enjoyed great success as glaucoma therapy for many years, recently the excimer laser trabeculotomy is a promising IOP-lowering technique.

Visual acuity in central and branch vein retinal occlusion in the presence of macular edema: 1 year of follow-up.

One year after laser treatment of 117 eyes with central or branch retinal vein occlusion in the presence of macular edema, visual acuity was equally improved in the central retinal vein occlusion laser-treated and branch retinal vein occlusion non-laser-treated eyes. We concluded that fluorangiographically evident ischemic areas or significant macular edema are indications for laser therapy, and that a poor long-term functional prognosis is always related to more severe macular damage at the onset.

Electro-oculography in pigment dispersion syndrome.

Clinical data and the common embryological origin of the pigment epithelium of the iris and retinal pigment epithelium suggest that the latter may be involved in the pigment dispersion syndrome (PDS). In our study functional changes of the retinal pigment epithelium were evaluated by electro-oculography in 10 PDS patients, 10 patients with chronic open-angle glaucoma (COAG) and 10 normal subjects. The mean dark-trough latency and Arden ratio for the PDS group were significantly lower than those of the COAG and control groups. Analysis of the Arden ratios based on the Kruskall-Wallis test revealed that 30% of the PDS values were subnormal with respect to the control group mean -1 SD. These results indicate primary involvement of the retinal pigment epithelium in PDS.

Laser and glaucoma: our experience.

The authors present some guidelines on laser therapy (Argon and/or Yag) application on the different types of glaucomatous pathology. These therapeutic guidelines are the result of a 3-year experience of constant laser therapy application on glaucoma. The case reports include 196 A-laser trabeculoplasties, 34 A-laser iridotomies, 158 Yag-laser iridotomies, 31 gonioplasties, plus numberless combined treatments (iridotomy-trabeculoplasty, gonio-trabeculoplasty, gonioplasty-ciliary body photocoagulation, and so on). The authors conclude by reaffirming the considerable reliability of these techniques, given a prolonged follow-up; they also advance some new therapeutic hypotheses on laser operation in glaucomas.