An Unusual Presentation of Pediatric Conjunctival Mucosa-Associated Lymphoid Tissue Lymphoma.

Ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma is uncommon in the pediatric population. Initial misdiagnosis is common and there is lacking consensus regarding the optimal approach to treatment. Herein, we report an atypical presentation of pediatric conjunctival MALT lymphoma and review the presentation and management of this rare condition.

Intravitreal triamcinolone-induced elevated intraocular pressure is associated with the development of posterior subcapsular cataract.

OBJECTIVE: To investigate the association between elevated intraocular pressure (IOP) and accelerated cataract formation in patients treated with intravitreal triamcinolone. DESIGN: Analysis of longitudinal data from a randomized, double-masked, placebo-controlled trial of intravitreal triamcinolone for age-related macular degeneration (the Intravitreal Triamcinolone Study). PARTICIPANTS AND CONTROLS: Patients with phakic eyes who participated in a randomized clinical trial of intravitreal triamcinolone for age-related macular degeneration were studied. There were 57 phakic eyes in the treatment group and 54 phakic eyes in the control group. One eye per patient was studied. INTERVENTION: Four milligrams of intravitreal triamcinolone or 1 ml subconjunctival saline. MAIN OUTCOME MEASURES: Intraocular pressure rise of at least 5 mmHg (IOP responders) and progression of posterior subcapsular cataract by 2 or more grades using photographic standards from the Age Related Eye Disease Study. RESULTS: Progression of posterior subcapsular cataract (PSC) by 2 or more grades in the treatment group was significantly higher among 16 IOP responders (51% after 2 years) than among 37 nonresponders (3%; P<0.0001, log-rank test). There was no significant progression of PSC in the placebo group or the opposite eye of the treatment group. Progression of cortical cataracts also was significantly higher among responders than nonresponders (15% vs. 3%; P = 0.015, log-rank test). The progression of nuclear cataracts (13% vs. 3%) was not significantly different between IOP responders and nonresponders (P = 0.3, log-rank test). CONCLUSIONS: Although steroid-related cataracts are unlikely to develop in eyes that do not experience elevated IOP after intravitreal triamcinolone, those eyes that do also have a very high risk of rapidly experiencing posterior subcapsular lens opacification. This strong association suggests that the mechanism responsible for the development of steroid-induced PSC cataract and raised IOP may be similar.

Use of vitamin and zinc supplements and age-related maculopathy: the Blue Mountains Eye Study.

PURPOSE: To investigate relationships between vitamin and zinc supplement use and age-related maculopathy in a population-based sample. METHODS: We studied 2873 (79%) of the 3654 participants aged 49- 97 years who attended the cross-sectional Blue Mountains Eye Study and completed a detailed food frequency questionnaire, including type, dose and duration of supplement use. ARM was assessed during a masked grading of macular photographs. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression. RESULTS: After adjusting for multiple confounders, we found that no vitamin or zinc supplements were significantly associated with reduced prevalence of any ARM lesions in either eye. The OR for use of any vitamin supplement was 1.3 (CI 0.9-1.7, p = 0.11) for individuals with any retinal pigment changes. It was 1.1 (CI 0.8-1.5, p = 0.59) for those with any soft (large) drusen and 1.5 (CI 0.7-3.0, p = 0.31) for those with late ARM lesions. The lack of association between supplement intake and ARM persisted regardless of their duration of use, dose or the smoking status of participants. The Breslow-Day test for heterogeneity was 0.24 with an OR for early ARM lesions among smokers of 0.7 (CI 0.4-1.3, p = 0.27), and 1.2 (CI 0.9-1.5, p = 0.24) among non-smokers. CONCLUSION: This cross-sectional population-based study investigated associations between vitamin and zinc supplement use and the prevalence of ARM lesions. Our findings provide no support for a protective association between vitamin and zinc supplement use and lesions indicating early ARM. The small numbers of subjects with late ARM lesions precluded any detailed investigation of benefits from supplement use on the prevalence of these lesions.