Conjunctival myxoid stromal tumor of the palpebral conjunctiva: A case report.

PURPOSE: To present the importance of considering conjunctival myxoid stromal tumors in the differential when evaluating eyelid lesions as these tumors could indicate undetected systemic syndromes including Zollinger-Ellison Syndrome, Carney complex, and other endocrine disorders. OBSERVATIONS: We present the case of a 56-year-old Caucasian female who was evaluated for a solid cyst-like structure of the palpebral conjunctiva just temporal to, but not involving, the left lower eyelid punctum. The lesion was removed with histopathologic examination of the specimen revealing the lesion to be a myxoid spindle cell tumor, consistent with conjunctival myxoid stromal tumor. CONCLUSIONS AND IMPORTANCE: Myxoid tumors are an abnormal proliferation of mesenchymal cells. These are most commonly found in the heart and less commonly in the bone, skin, and skeletal muscle. Myxoid tumors of the conjunctiva are a very rare reported finding and most reported cases involving the conjunctiva occur on the bulbar conjunctiva. Our patient was found to have a conjunctival myxoid stromal tumor of the palpebral conjunctiva. As these are rare lesions, we believe that considering this as a differential when evaluating eyelid margin lesions is important due to the association of these tumors with systemic conditions including Zollinger-Ellison Syndrome, Carney complex, and other Endocrine disorders.

First Reported Case of Proliferative Retinopathy in Hemoglobin SE Disease.

We report the first case of proliferative sickle cell retinopathy in a patient with hemoglobin SE (Hb SE) disease. Only a few dozen cases of Hb SE disease have been reported previously, and none had evidence of proliferative retinopathy. A 56-year-old African American man presented to our clinic for routine examination and was found to have sea-fan peripheral neovascularization bilaterally without maculopathy. Hemoglobin analysis revealed Hb SE heterozygosity. Sector laser photocoagulation to areas of nonperfusion in both eyes resulted in regression of the peripheral neovascularization over a period of 6 months. Although Hb SE disease is rare, the incidence of Hb SE disease is postulated to rise in the future. Awareness of its potential ocular complications is needed to appropriately refer these patients for screening.

The incidence of retinal vein occlusion in the ocular hypertension treatment study.

OBJECTIVE: To determine the incidence of retinal vein occlusion (RVO) in the Ocular Hypertension Treatment Study (OHTS). DESIGN: Retrospective analysis of data from a randomized clinical trial. PARTICIPANTS: We included 1636 ocular hypertensive participants with a mean follow-up of 9.1 years. Participants in the medication and observation groups were managed according to their original randomization assignment until June 1, 2002. At that time, the observation participants were offered ocular hypotensive treatment. Data to July 1, 2005, are included in this report. METHODS: Occurrences of RVO in study participants, categorized as branch, central or hemicentral vein occlusion, were documented. Potential RVO events were identified by a keyword search of Adverse Event Reports, the Optic Disc Reading Center database, Endpoint Committee reviews, and by response to a written request for information sent to each clinical site. To confirm a potential RVO, the complete OHTS chart was reviewed. Statistical analyses included t tests, chi-square tests and Cox proportional hazards models. MAIN OUTCOME MEASURES: Incidence of RVO. RESULTS: Twenty-six RVOs-5 branch, 14 central, and 7 hemicentral RVOs-were confirmed in 23 participants (15 observation and 8 medication). The 10-year cumulative incidence of RVO was 2.1% in the observation group and 1.4% in the medication group (P = 0.14; log-rank test). At baseline, participants who later developed a RVO were significantly older (65.1 vs 55.3 years; P = 0.01), and had greater horizontal cup-to-disc ratios (P = 0.0004). CONCLUSIONS: Although the incidence of RVO was higher in the observation group than the medication group, this difference did not attain significance. Consistent with some previous studies, older age and greater cup-to-disc ratio were associated with the development of RVO.

The macular automated photostress test.

PURPOSE: To introduce a standardized macular photostress test using an automated perimeter as a method to quantify macular disease severity and as a tool to distinguish optic neuropathy from macular pathology. DESIGN: Prospective interventional pilot study. METHODS: Twenty-five bilaterally pseudophakic subjects aged range, 65 to 84: 15 patients with varying severity of non-neovascular age-related macular degeneration (AMD), five patients with no ocular disease, and five patients with moderate primary open-angle glaucoma (POAG). Previously reported normative values served as controls for this study. Patients underwent foveal threshold testing using the Humphrey Visual Field Perimeter Model 750 (Carl Zeiss Meditec, Inc, Dublin, California, USA). Baseline measurements were compared to threshold sensitivity after photostress at one minute and then two-minute intervals until sensitivity returned to baseline. Main outcome measures were baseline foveal threshold sensitivity, foveal threshold depression, and recovery following photostress. RESULTS: Automated macular photostress testing in macular disease (AMD) causes a decrease (P < .001) in baseline foveal sensitivity and a delay (P < .001) in recovery time to baseline sensitivity. Optic nerve pathology (POAG) does not affect (P = .343) the foveal response curve. CONCLUSIONS: The macular automated photostress (MAP) test is an inexpensive, noninvasive, and readily accessible adjunct for evaluating patients with macular disease. This standardized protocol is useful in objectively defining disease severity, may be used to follow response to treatment, and could aid in distinguishing optic neuropathy from macular pathology.

Macular photostress testing: sensitivity and recovery with an automated perimeter.

PURPOSE: To describe a novel method for the evaluation of macular function with photostress testing and outline normative foveal threshold and recovery data for the adult population. METHODS: In this prospective study, 50 adult subjects (25 men and 25 women aged 30-49 years) with no ocular disease underwent foveal threshold testing using the Humphrey Visual Field Perimeter Model 750. Baseline values and recovery time after photostress were measured. Baseline measurements were compared with threshold sensitivity after photostress at 1, 2, 4, 6, and 10 minutes. RESULTS: Mean foveal sensitivities were reduced from 38.53 db to 32.36 db after photostress, representing an average sensitivity reduction of 16%. The mean recovery time to baseline sensitivity was 6.58 minutes. There was no significant difference between sexes, races, or smokers and nonsmokers. CONCLUSIONS: This standardized protocol for testing the foveal threshold response to photostress is an inexpensive and noninvasive adjunct for following macular disease and also distinguishing optic neuropathy from macular disease.