Sebaceous gland carcinoma of the eyelid: clinicopathological features and outcome in Asian Indians.

PURPOSE: To study the clinical and histopathological features of eyelid sebaceous gland carcinoma (SGC) and to evaluate the prognosis in the Asian-Indian population. METHODS: This is a retrospective study of 191 patients with SGC. RESULTS: The mean age at presentation of eyelid SGC was 57 years (median, 56 years). The tumor epicenter was most commonly located in the upper eyelid (n=125, 65%). The mean tumor basal diameter was 15 mm (median, 10 mm). There was evidence of tumor extension into the orbit (n=30, 16%), paranasal sinuses (n=3, 2%), and brain (n=1, 1%). Wide excision biopsy (n=146, 78%) was the most common treatment modality. Tumor recurrence was noted in 42 (24%) patients over a mean follow-up period of 29 months (median, 20 months). On the basis of the Kaplan-Meier estimate, lymph node metastasis occurred in 18%, systemic metastasis was detected in 10%, and death occurred in 2% of patients at 10 years. On multivariate analysis, the factors predicting locoregional lymph node and systemic metastasis were medial canthal involvement (P=0.004; P=0.013), lateral canthal involvement (P=0.013; P=0.025), tumor basal diameter >10 mm (P=0.002; P=0.002), and perivascular invasion (P=0.043; P<0.001), respectively. The factors predicting death due to metastasis on multivariate analysis were medial canthal involvement (P=0.012) and tumor basal diameter >10 mm (P=0.001). CONCLUSION: Advanced eyelid SGC is a tumor associated with poor prognosis. In this study, canthal involvement, larger tumor diameter, and perivascular invasion were poor prognostic factors.

Outcomes of rectangular 3-snip punctoplasty in acquired punctal stenosis: is there a need to be minimally invasive?

AIM: To report the clinical profiles of acquired punctal stenosis and outcomes with rectangular 3-snip punctoplasty. METHODS: Retrospective chart review of all patients who underwent rectangular 3-snip punctoplasty, over a 3-year period from a single surgeon's (MJA) database was performed. Data retrieved include demographics, symptomatology, prior interventions, grades of punctal stenosis, associated ocular findings, and outcomes. A minimum follow-up of 6 months following punctoplasty was considered for analysis. Success was defined as clearance of dye on functional dye disappearance test and resolution of symptoms. RESULTS: One hundred and forty five puncta of 87 eyes of 56 patients were studied. The mean age at presentations was 52 years. Puncta (71.7%; 104/145) were of grade 2 size. Epiphora was the commonest presenting symptom noted in 94.3% (82/87) of the eyes. At a minimum follow-up of 6 months, complete resolution of symptoms was achieved in 74.7% (65/87) of eyes. Eight out of 87 eyes (9.1%) failed to show any improvement secondary to lacrimal obstructions distal to the puncta. Five out of 87 (5.7%) eyes showed punctal restenosis whereas 10.3% (9/87) of the eyes had functional epiphora post punctoplasty. CONCLUSION: Puncta of grade 2 size were the most common in this series. Although rectangular 3-snip punctoplasty is an effective and safe procedure for majority of grades 1 and 2 of acquired punctal stenosis, a higher percentages of functional epiphora and punctal restenosis in the remaining patients should propel further investigations into developing nonincisional, minimally invasive alternatives.