Yamada's surgery for treatment of myopic strabismus fixus.

PURPOSE: Myopic strabismus fixus is characterized by acquired progressive esotropia and hypotropia associated with restricted elevation and abduction. Treatment is difficult, with recurrence of the large-angle esotropia even after surgery. The aim of this study was to describe two cases of myopic strabismus fixus successfully treated with Yamada's surgical technique. METHODS: Two patients with myopic strabismus fixus were submitted to hemitransposition of the superior rectus (SR) and lateral rectus (LR) muscles with scleral fixation at 7 mm from the limbus. In one patient, the hemitransposition was associated with ipsilateral MR muscle recess as described by Yamada, while in the other, botox injection into the MR muscle was performed. In both cases Yamada's procedure was associated with 4 mm resection of the hemitransposed portions of the SR and LR muscles to increase the muscular tonus and then improve surgical effects. RESULTS: The patient submitted to the MR recess presented with satisfactory ocular alignment after 6 months postoperative. The other patient submitted to botox injection at the MR muscle presented recurrent esotropia after 3 months. RM recess was then performed and an excellent ocular alignment was achieved. CONCLUSIONS: Yamada's surgical technique can provide acceptable ocular alignment in cases of myopic strabismus fixus. The surgical effects can be potentialized with resection of the hemitransposed portions of the SR and LR muscles. In addition, we demonstrated that botulinum toxin injection at the RM muscle is not an effective treatment in these cases.

Immunohistochemical panel of undifferentiated orbital metastatic carcinomas.

PURPOSE: To examine the applicability of an immunohistochemical panel of seven monoclonal antibodies to identify the primary site of poorly differentiated orbital metastatic carcinomas. MATERIAL AND METHODS: Immunohistochemistry was performed to detect cytokeratin (CK) 7, CK20, thyroid transcription factor-1 (TTF-1), BRST1, BRST2, carcinoembryonic antigen (CEA) and prostate-specific antigen (PSA) in seven cases of poorly differentiated orbital metastases. Of the seven cases, four were female and three male. The youngest patient was thirty-six while the oldest was eighty-eight years of age. RESULTS: The immunohistochemical panel alone was helpful to identify the primary source of the metastatic lesion in three out of the seven cases. Two of them were metastatic breast carcinomas (BRST1, BRST2 positive) and one was a prostate carcinoma (PSA positive). By correlating the immunohistochemical results with the previous clinical history, the primary site could be identified in two more cases. In those metastatic lesions, the positive staining for CK7, CK20, and CEA, associated with negative staining for BRST1, BRST2, PSA and TTF-1, indicated bladder as the probable primary site. In two out of seven cases, the metastatic tumor was only positive for CEA, therefore a primary site could not be identified. CONCLUSIONS: An immunohistochemical panel of poorly differentiated orbital metastases is helpful in the identification of the primary tumor site. The association of seven markers with the patient's clinical history allowed for the positive identification of the primary tumor in the majority of these cases.

Histopathological diagnosis of corneal button specimens: an epidemiological study.

PURPOSE: To determine the most common histopathological diagnosis of corneal specimens from penetrating keratoplasty (PKP). METHODS: The records of 500 corneal specimens submitted to biopsy at the Henry Witelson Ocular Pathology Laboratory, Montreal, Canada, from 1999 to 2004 were reviewed. Age, sex, clinical indications, and histopathological findings were analyzed. RESULTS: Chronic keratitis (45.6%) was the most common pathological diagnosis, followed by corneal edema (25.8%), dystrophy (12.8%), keratoconus (KC) (9.2%), acute keratitis (5.6%), and degeneration (1.0%). Among the specimens with chronic keratitis, regraft was the most common clinical indication (39.0%). In the group of acute keratitis, ulcerative condition was the leading cause (75,0%). Fuchs' endothelial dystrophy represented 79.7% of the clinical diagnoses in the group of corneal dystrophies. The median patient age was 70-79 years, and the gender distribution was nearly symmetric. CONCLUSION: The present study is important for determining the most common histopathological diagnoses of corneal button specimens and the correlation with the age, gender, and clinical indications of PKP.

Immunohistochemical expression of COX-2 and c-kit in metastatic uveal melanoma.

CASE REPORT: We report a case of choroidal melanoma metastatic to the liver diagnosed by fine-needle aspiration. The biopsy sample was immunostained for COX-2 and c-kit. COMMENTS: Accurate diagnosis and identification of potential therapeutic targets are important for subsequent therapy and can be achieved by radiologically guided fine-needle aspiration biopsy.

Expression of EpCAM in uveal melanoma.

BACKGROUND: Uveal melanoma (UM) is the most common primary intraocular malignant tumor in adults, and nearly 40% of UM will develop metastasis that will ultimately lead to death. The Epithelial Cell Adhesion Molecule (EpCAM) is a type I transmembrane glycoprotein expressed by carcinomas of head and neck, ovary, colon, breast, kidney and lung. Recently, antibodies against EpCAM such as Edrecolomab and Catumaxomab were developed, and clinical trials with these antibodies have been used in several types of neoplasia. We studied the expression of EpCAM in UM. METHODS: 25 enucleated formalin-fixed, paraffin-embedded UM specimens were immunostained for EpCAM. Histopathological analysis of the specimens with regards to prognostic factors such as cell type, largest (linear) tumor dimension, number of mitotic figures, scleral invasion and tumor infiltrating lymphocytes were done. RESULTS: None of them was positive for this EpCAM. CONCLUSION: In our report, UM did not express EpCAM. Therefore, it is not a helpful immunohistochemical marker to predict the behavior of UM. Further studies are needed to verify if EpCAM could also be related with prognosis and treatment of UM.

Prostate-specific membrane antigen is undetectable in choroidal neovascular membrane.

BACKGROUND: Choroidal neovascular membrane (CNVM) is one of the leading causes of severe visual loss and is often associated with age-related macular degeneration (AMD). Various modalities of treatment, including photocoagulation and surgery, are being considered as options, but with limited success. Prostate-specific membrane antigen (PSMA) is a type II membrane glycoprotein expressed in benign and malignant prostatic tissues, in some non-prostatic tissues, and in the endothelium of tumor-associated neovasculature of non-prostatic neoplasm. Some studies have suggested that the expression of PSMA is restricted to endothelium from tumor-associated neovasculature and might be stimulated by some tumor-secreted angiogenic factors. However, no previous study demonstrating PSMA expression in non-related tumor neovasculature, such as CNVM, has been performed to date. Furthermore, demonstration of PSMA expression in CNVM in AMD patients could reveal a novel target for antineovascular therapy. The purpose of this study was to evaluate the immunohistochemical expression of PSMA in CNVM from AMD. METHODS: Immunohistochemical analysis, with a standard avidin-biotin complex technique, was performed using an anti-PSMA mouse monoclonal antibody in 30 specimens of surgically excised CNVM from AMD patients. Antibody to an endothelial cell specific marker, factor VIII, was used to confirm the location of the endothelial cells. RESULTS: The angiogenic microvessels of the 30 cases demonstrated negative staining to PSMA while factor VIII was expressed in all cases. Seventy-five percent of the secretory-acinar epithelium of the prostatic hyperplasia specimen stained positive, confirming that the immunohistochemical technique was correctly performed. CONCLUSION: The absence of PSMA expression in non-tumoral neovasculature supports the theory, previously suggested, that endothelial cell PSMA expression may be stimulated by one or more tumor-secreted angiogenic factors. Angiogenesis is very important in neoplasia and the endothelial expression of PSMA in tumor-associated neovasculature may represent a target for antineovasculature-based therapy. The absence of PSMA expression in CNVM suggests that PSMA may not be a potential target for antineovasculature-based therapy.

Traumatic tear of the inferior rectus muscle treated with inferior oblique anterior transposition.

PURPOSE: To report a case of traumatic tear of the inferior rectus muscle treated with inferior oblique anterior transposition (IOAT). METHODS: Case report of a 55-year-old man who presented with vertical diplopia (VD) after orbital trauma. Ocular examination disclosed a 62PD right hypertropia (RHT) in the primary position (PPO). The right inferior rectus (RIR) was torn, and the distal stump was fixed to the skin with tape. RESULTS: Surgery was performed under local anesthesia. The RIR tearing occurred 13 mm from the insertion, and exploration revealed its proximal end. The right inferior oblique (RIO) was intact, although its fibers were loose. Since the RHT did not improve following reattachment of the proximal and distal stumps of the RIR, the distal stump was excised and the proximal end brought forward and sutured 6.5 mm from the limbus. At perioperative evaluation, there was a 25PD RHT in PPO where the VD persisted. The RIO was subsequently isolated, detached, and its distal end, after 6 mm resection, was sutured to a point temporal to the lateral border of the RIR. The patient was reevaluated and had neither RHT nor VD in primary gaze. At the 6-week postoperative evaluation, he was orthotropic in PPO, complaining about diplopia only on extreme downgaze. A mild limitation of right depression was observed. The patient was satisfied with the surgical results and experienced no functional limitations during any activities. CONCLUSION: IOAT can provide acceptable binocular visual function without the risk of anterior segment ischemia in cases of torn inferior rectus muscle.