Hypertrophic changes of the lower eyelid margin after hughes procedure for eyelid reconstruction: the management and outcomes.

PURPOSE: To describe the management of lower eyelid margin hypertrophy as a complication of the Hughes procedure for eyelid reconstruction. METHODS: A retrospective review of all patients with lower eyelid hypertrophy after Hughes procedure. Patient demographics, management, histologic findings, and outcomes were recorded. The patients underwent wedge excision of the hypertrophic segment of the eyelid with direct closure achieved in the majority of cases. RESULTS: Five patients were identified. The mean age at presentation was 66 years. The mean onset for the hypertrophic margin was 8.4 weeks after the Hughes flap. Four patients complained of ocular irritation and 1 patient had a constant ocular discharge. All patients were concerned by the appearance of the eyelid margin. Four patients received topical steroid treatment and 4 patients underwent triamcinolone subcutaneous injections with no improvement. The wedge excision was successful in 4 patients at the mean follow-up of 10 months, with no recurrence of the hypertrophic margin. One patient was reviewed in another center. CONCLUSION: The authors found no beneficial effect with topical or subcutaneous courses of steroids on eyelid margin hypertrophy. In situations of horizontal eyelid laxity, a full-thickness wedge excision offers a good means of removing the offending eyelid segment.

Retrospective study of an as required dosing regimen of intravitreal bevacizumab in neovascular age-related macular degeneration in an Australian population.

PURPOSE: To investigate the efficacy of intravitreal bevacizumab for the treatment of neovascular age-related macular degeneration (AMD) using an as required dosing regimen. METHODS: A retrospective study of 210 patients (231 eyes) with choroidal neovascularization resulting from neovasacular AMD. Patients were treated with 1.25 mg intravitreal bevacizumab at a vitreoretinal practice in Adelaide, South Australia. Patients were followed up at 2-4 weeks and then at 1-month intervals; repeat injections were offered in the event of recurrence. Recurrence was defined as either a decrease of best-corrected visual acuity or an increase in macular oedema, subretinal fluid or intraretinal fluid on optical coherence tomography, after complete or partial resolution in previous follow-up visits. Patient data were collected for 12 months of follow up or until the patient's treatment was changed to ranibizumab. RESULTS: Significant improvement in visual acuity and central retinal thickness was demonstrated at 1 month with an improvement of vision from logMAR equivalent 0.76 to 0.68 (P < 0.001) and a decrease of central retinal thickness from 306 µm to 244 µm (P < 0.001). This overall improvement was continued throughout the 12-month follow-up period; however, follow up was poor with 12-month data available for only a small number of patients (7.8%). Ocular and systemic side-effects were rare at 3.5% and 0.4%, respectively. CONCLUSION: Eyes with neovascular AMD treated with intravitreal bevacizumab for up to 12 months had significant functional and anatomical improvement. Further studies need to confirm the long-term safety and efficacy of this treatment.

Clinicopathological correlation in pituitary gland metastasis presenting as anterior visual pathway compression.

Pituitary gland metastases, albeit rare, remain an important differential in sellar and suprasellar tumours. Clinical and radiological features of pituitary metastases may be indistinguishable from benign suprasellar lesions such as a pituitary adenoma. Histopathology with immunohistochemical assay remains the key to the diagnosis of pituitary metastasis. We describe four patients with sellar lesions presenting with anterior visual pathway compression initially diagnosed as pituitary adenomas who on immunohistochemistry were found to have metastases to the pituitary. Classification of the cell histology determined the primary site of origin in some patients. This series demonstrates the importance of combining histopathology and immunohistochemistry in the diagnosis of suprasellar lesions.

Bilateral occipital lobe infarction with altitudinal field loss following radiofrequency cardiac catheter ablation.

BACKGROUND: Bilateral stroke following radiofrequency catheter ablation is an unusual complication and may result in bilateral altitudinal visual field defects. Bilateral altitudinal visual field defects usually result from prechiasmal pathology causing damage to both retinas or optic nerves and rarely from bilateral symmetric damage to the post chiasmal visual pathways. CASE PRESENTATION: A 48-year-old man complained of visual disturbance on wakening following radiofrequency catheter ablation. The patient had a CHADS score of 1 pre-operatively and no complications were noted intra-operatively. Examination revealed a bilateral superior altitudinal defect and MRI of the brain showed multifocal areas of infarction predominantly involving the occipital lobes which correlated to with the visual deficits. CONCLUSION: While the risk of thromboembolism and perioperative stroke during radiofrequency catheter ablation is small, it is not insignificant.