Second primary malignancies of eye and ocular adnexa after a first primary elsewhere in the body.

PURPOSE: The eye and its adnexal structures can give rise to first or consecutive primary malignancies or to encounter metastasis. Our aim was to define the characteristics of the second primary neoplasms affecting the eye and its adnexa and find the risk modifying factors for them after malignancies elsewhere in the body. METHODS: We have queried the Surveillance, Epidemiology and End-Results "SEER"-9 program of the National Cancer Institute for the malignancies of the eye and its adnexa that occurred between 1973 and 2015. The malignancies were ordered chronologically according to their incidence: first or second primary malignancies. The tumors were classified according to ICD-O-3 classification. Standardized incidence ratios (SIR) and survival probabilities were calculated for subgroups. RESULTS: Among 3,578,950 cancer patients, 1203 experienced a second malignancies of the eye and its adnexa. The first malignancy was diagnosed between 50 and 69 years of age in 58.94% of them. The eyelid showed 280 events, while 50 in lacrimal gland, 181 in the orbit, 21 in the overlapping lesions, 15 in optic nerve, 148 in the conjunctiva, 9 in the cornea, 6 in the Retina, 379 in the choroid, and 93 in the ciliary body. The SIR of a second malignancy after a prior non-Hodgkin lymphoma was 2.42, and in case of previous skin carcinomas it was 3.02, melanoma of skin, and 2.13 and 1.58 in oral cavity/pharynx malignancies. The second ocular and adnexal neoplasms increased steadily over the 5-year periods on contrary to first primary neoplasms. The survival of patients affected with first ocular and adnexal neoplasms was significantly higher than those with second ocular and adnexal neoplasms. On the other side, second primary ocular and adnexal tumors showed a better survival than second primary malignancies elsewhere. CONCLUSIONS: The epidemiological differences between first and second ocular and adnexal primaries suggest different underlying mechanisms. Careful ocular examination should be integrated in the long-term follow-up plan of cancer patients. Special attention should be given to patients with non-Hodgkin's lymphoma and melanoma as first primary.

Subfoveal choroidal thickness in diabetic macular edema.

Purpose: To evaluate subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) using spectral domain OCT (SD-OCT). Materials and methods: Ninety eyes were divided into three equal groups: group A, non-proliferative diabetic retinopathy (NPDR) with no DME; group B, NPDR having DME; and group C, non-diabetic patients. The central subfield retinal thickness (CSRT) and SFCT were measured using spectral domain OCT. Results: There was a moderate negative correlation between age and SFCT in group B (r=-0.455, P=0.012). We found no significant correlation between best corrected visual acuity (BCVA) and SFCT in all groups (for groups A, B, and C, respectively: r=0.189, P=0.316; r=-0.195, P=0.302; and r=-0.181, P=0.337). There was no significant correlation between duration of diabetes and SFCT (r=-0.118, P=0.534 and r=-0.136, P=0.475 for groups A and B, respectively). The CSRT was 229.13±16.2, 336.4±74.85, and 223.13±16.9 µm in groups A, B, and C, respectively. The mean SFCT was 260.6±49.2, 259±50.8, and 252±50 µm in groups A, B, and C, respectively. We found no significant correlation between CSRT and SFCT in all groups (for groups A, B, and C, respectively: r=-0.049, P=0.796, r=0.239, P=0.204, r=-0.021, P=0.914). There was no significant difference in SFCT between group B (DME) on one hand and groups A and C on the other hand (P=0.9 and 0.59, respectively). Conclusion: There is no significant correlation between CSRT and SFCT in DME. Choroidal thickness assessment is not an indicator of the severity of DME and cannot be used as a monitor of its progression.

Efficacy of addition of nepafenac 0.1% to steroid eye drops in prevention of post-phaco macular edema in high-risk eyes.

PURPOSE: To compare the efficacy of addition of nonsteroidal anti-inflammatory eye drops to steroidal eye drops with that of using postoperative steroidal anti-inflammatory eye drops alone in prevention of macular edema in high-risk patients. SETTING: Cairo University Hospital. DESIGN: This study was comparative prospective interventional randomized study. METHODS: This study included 100 cataractous eyes divided into five subgroups: 20 eyes of diabetic patients, 20 uveitic eyes, 20 traumatic cataracts, 20 glaucomatous eyes on topical prostaglandin analogs, and 20 eyes with posterior capsular rupture during phacoemulsification. Each subgroup of 20 was randomized between two groups of 10 eyes, group A received postoperative topical steroids alone and group B received both steroidal and nonsteroidal anti-inflammatory eye drops. RESULTS: There was significant increase in postoperative central foveal thickness as compared to preoperative values in both groups (60.9 ± 87.95 µ in group A and 25.52 ± 57.26 µ in group B) that was significantly more in group A (P value 0.016). There was significant difference in postoperative macular thickness between both groups (280.1 ± 86.0 µ and 246.80 ± 57.73 µ, respectively, in groups A and B) (P value = 0.012). There was no statistically significant difference between both groups in preoperative and postoperative corrected distance visual acuity and intraocular pressure. CONCLUSION: Addition of topical nepafenac eye drops to topical steroid drops significantly reduced the amount of pseudophakic macular edema after cataract surgery in high-risk eyes.

Incidence of Posterior Vitreous Detachment After Femtosecond LASIK Compared With Microkeratome LASIK.

PURPOSE: To compare the incidence of posterior vitreous detachment (PVD) after femtosecond and microkeratome laser in situ keratomileusis (LASIK). SETTING: Rowad Correction Centre, Cairo, Egypt (a private center affiliated to Cairo University). DESIGN: Prospective, nonrandomized comparative unmasked study. METHODS: The study was conducted at a single laser center. Eligible patients chose between femtosecond and microkeratome LASIK after appropriate counseling. B-scan ultrasonography was performed before surgery by a single operator. Patients with preexisting PVD (partial or complete) were excluded. The axial length was also recorded. All surgery was performed by a single surgeon. During surgery, the suction time was measured. Ultrasonography was repeated 1 month after surgery by the same operator to detect PVD. RESULTS: Ten patients (20 eyes, group M) underwent LASIK using the Moria M2 microkeratome, and 10 patients (20 eyes, group F) underwent femtosecond LASIK with the IntraLase FS-150. In groups M and F, respectively, the proportion of women was 80% and 70%, and the mean age was 24.7 ± 4 years and 25.7 ± 3.3 years, the mean axial length was 24.2 ± 1.2 and 23.8 ± 1.2 mm, and the mean suction time was 18 ± 2 seconds and 63 ± 4 seconds (P < 0.001). After surgery, PVD was detected in 4 eyes (20%) in group M and 17 eyes (85%) in group F (P = 0.000044). CONCLUSIONS: The incidence of PVD 1 month after femtosecond LASIK was higher than after microkeratome LASIK. This may be due to longer suction time during femtosecond LASIK despite lower suction pressure.