An international survey of classification and treatment choices for group D retinoblastoma.

AIM: To determine which IIRC scheme was used by retinoblastoma centers worldwide and the percentage of D eyes treated primarily with enucleation versus globe salvaging therapies as well as to correlate trends in treatment choice to IIRC version used and geographic region. METHODS: An anonymized electronic survey was offered to 115 physicians at 39 retinoblastoma centers worldwide asking about IIRC classification schemes and treatment patterns used between 2008 and 2012. Participants were asked to record which version of the IIRC was used for classification, how many group D eyes were diagnosed, and how many eyes were treated with enucleation versus globe salvaging therapies. Averages of eyes per treatment modality were calculated and stratified by both IIRC version and geographic region. Statistical significance was determined by Chi-square, ANOVA and Kruskal-Wallis tests using Prism. RESULTS: The survey was completed by 29% of physicians invited to participate. Totally 1807 D eyes were diagnosed. Regarding IIRC system, 27% of centers used the Children's Hospital of Los Angeles (CHLA) version, 33% used the Children's Oncology Group (COG) version, 23% used the Philadelphia version, and 17% were unsure. The rate for primary enucleation varied between 0 and 100% and the mean was 29%. By IIRC version, primary enucleation rates were: Philadelphia, 8%; COG, 34%; and CHLA, 37%. By geographic region, primary enucleation rates were: Latin America, 57%; Asia, 40%; Europe, 36%; Africa, 10%, US, 8%; and Middle East, 8%. However, systemic chemoreduction was used more often than enucleation in all regions except Latin America with a mean of 57% per center (P<0.0001). CONCLUSION: Worldwide there is no consensus on which IIRC version is used, systemic chemoreduction was the most frequently used initial treatment during the study period followed by enucleation and primary treatment modality, especially enucleation, varied greatly with regards to IIRC version used and geographic region.

Gender and Racial Disparities in Cases of Autoenucleation.

OBJECTIVE: This review demonstrates the gender and racial disparities among patients who have committed ocular autoenucleation. DESIGN: Peer-reviewed articles were identified and reviewed on the basis of a literature search in PubMed/MEDLINE and Ovid/EMBASE databases from all available literature to date. RESULTS: We identified 60 cases of autoenucleation published in contemporary literature with nine attempted cases. The ratio of men to women who have committed autoenucleation is 8:1. Only 28 cases of autoenucleation included confirmed reports of racial makeup. 17 out of 28 cases were White, eight out of 28 cases were Hispanic or Asian, and only three cases were Black. White patients account for 61% of the cases, while Black patients make up 11% and other races constitute 28%. The common underlying psychiatric motivations among autoenucleation patients include biblical interpretations, religious delusions, and paranoia of the eye. The most common associated psychiatric disorders among patients with autoenucleation include schizophrenia, major depressive disorder, and bipolar disorder. CONCLUSION: Autoenucleation largely occurs amongst male patients with active psychiatric disorders. Our findings challenge previously published reviews where the incidence of autoenucleation is reported as equal for the two sexes. A higher incidence among the White population is also suggested. This is the first time gender and racial disparity have been demonstrated with respect to autoenucleation.

Racial Disparities in Corneal Transplantation Rates, Complications, and Outcomes.

Corneal transplantation is a common type of tissue transplantation that aims to improve vision or relieve pain. Given the immune privilege of the cornea, the primary graft often has a high success rate, approaching 90%. Despite the good overall outcome of corneal transplantation in various studies, the individual graft survival rate varies, depending on the preoperative diagnosis and donor and recipient factors. Race and ethnicity have been shown to be important in other types of organ transplantation. The aim of this study was to review the available ophthalmic literature regarding any differences in rates and outcomes of corneal transplantation based on ethnicity and race. A small body of evidence suggests that race might be an important risk factor for graft rejection and graft failure. More robust studies are needed to clarify these associations.

Racial Influences of Uveitic Glaucoma: Consolidation of Current Knowledge of Diagnosis and Treatment.

INTRODUCTION: The etiology, frequency, manifestation, and treatment of uveitis and uveitic glaucoma are commonly influenced by race. MATERIALS AND METHODS: This study aims to review the effect of race on the diagnosis and treatment of patients with common diseases of uveitis that may develop into glaucoma. RESULTS: Race affects the presentation and prevalence of uveitis. Sarcoidosis, for example, is more common in Blacks than in Whites in the United States. Furthermore, Blacks more commonly have anterior segment involvement, while Whites more commonly have posterior segment involvement. In addition, treatments-such as steroid implants and trabeculectomy-in the setting of uveitis and uveitic glaucoma may have higher risk of failure in Black patients. DISCUSSION: Over the last half-century, we have increased our understanding of the role of race in uveitis and uveitic glaucoma. Major gaps remain and further study is needed.

A Comprehensive Review of Sex Disparities in Symptoms, Pathophysiology, and Epidemiology of Dry Eye Syndrome.

INTRODUCTION: The etiology, frequency, manifestation, and treatment of dry eye syndrome are commonly influenced by sex and gender. MATERIALS AND METHODS: This study aims to review the differences in epidemiology, pathophysiology, and associated diseases between the sexes. The terms men and male and women and female are used interchangeably throughout the review to refer to biological sex. RESULTS: There are numerous objective and subjective markers of dry eye syndrome but not one diagnostic criterion. There are numerous associated conditions with dry eye syndrome varying from autoimmune to allergic. Large epidemiologic studies reviewed suggest that there does indeed exist a difference between dry eye symptoms between men and women, with women having dry eye signs and reporting dry eye symptoms more often than men. The increased prevalence in women could be correlated to an increased association with certain systemic diseases, specifically autoimmune diseases, and to hormonal variations. Several studies found equivocal data about prevalence of dry eye symptoms between men and women. DISCUSSION: Interpreting studies that investigate epidemiology, pathogenesis, and treatment of dry-eye conditions is complicated by the lack of universally adapted diagnostic criteria and standardized, specific diagnostic tests, and inter-study variability in the definition of dry eye syndrome.

Socioeconomic Disparities in the Presentation of Acute Bacterial Sinusitis Complications in the Pediatric Population.

Acute bacterial sinusitis is a common disease in the pediatric population that typically resolves without significant complications. Children who do suffer from complications involving the orbit or the brain often experience significant morbidity and potential mortality, typically requiring hospitalization for management. Numerous studies have demonstrated that children from low-income families with public or no insurance are less likely to receive adequate preventative care, are more likely to present with later disease stages, and ultimately endure worse health outcomes. We review the literature to examine if there are socioeconomic disparities in the presentation of complications of acute bacterial sinusitis in the pediatric population.

Transarterial Onyx Embolization of an Orbital Solitary Fibrous Tumor.

Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm sometimes found in the orbit. We report a case of an aggressive orbital SFT with enlarged feeding vessels that was successfully resected immediately after transarterial embolization with Onyx (ethylene vinyl alcohol copolymer). To our knowledge, this is the first report showing the histopathology of Onyx embolization material in an orbital SFT.

Big red flags in neuro-ophthalmology.

Specific red flag clinical signs in ophthalmology might indicate serious underlying systemic disease. This review illustrates five big red flags in neuro-ophthalmology of interest to comprehensive ophthalmologists. These clinical signs include: (i) retinochoroidal venous collaterals, (ii) optic disc edema with a macular star, (iii) chronic red eyes refractory to topical therapy, (iv) aberrant regeneration not secondary to ischemia, and (v) the misdiagnosis of immune disease in immunosuppressed patients. We also describe the common causative factors suggested by these red flags (i.e., optic nerve sheath meningioma, infectious neuroretinitis, carotid cavernous fistula, compressive third nerve lesions, and the incorrect diagnosis of Tolosa-Hunt syndrome [THS]), as well as the distinctive laboratory or radiographic signs for each condition.

PROSE therapy used to minimize corneal trauma in patients with corneal epithelial defects.

PURPOSE: To review the effectiveness of continuous or extended daily wear of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) for treating recurrent or persistent corneal epithelial defects from a variety of causes that were refractory to conventional therapy in 9 patients. DESIGN: Retrospective case series. METHODS: The medical records of 9 patients with a history of recurrent or persistent corneal epithelial defects resistant to conventional medical treatment who received treatment at the Cullen Eye Institute between January 2011 and July 2012 were reviewed. Demographic information, etiology, prior treatment, and outcome of PROSE treatment were analyzed. Recurrence after cessation of PROSE and complications were also identified. RESULTS: The etiologies of recurrent or persistent corneal epithelial defects in this series included neurotrophic keratopathy, lattice and Avellino dystrophy, Stevens-Johnson syndrome, and chemical/thermal injury. All patients were initially treated with bandage contact lens; however, continuous silicone hydrogel lens wear was not effective in preventing recurrence or healing corneal epithelial defects in all patients. Epithelial defects healed without recurrence in all 9 patients treated with PROSE. Eight patients developed recurrent epithelial defects when PROSE was discontinued, but rehealed after resuming PROSE. Visual acuity improved in 8 patients (88.9%) treated with PROSE. CONCLUSIONS: Complex persistent or recurrent corneal epithelial defects that failed to heal with extended silicone hydrogel contact lenses healed with PROSE. PROSE therapy was well tolerated, but corneal epithelial defects recurred in all but 1 case following cessation of therapy.