Melanoma uveal

Introducción: El melanoma uveal, es el cáncer intraocular más común en adultos, representa cerca del 3 % al 5 % de todos los melanomas; con un pico de incidencia en hombres en la sexta década de la vida. Objetivo: Describir la presentación clínica, diagnóstico y tratamiento de una paciente con melanoma uveal. Caso clínico: Paciente femenina de 39 años de edad, con antecedentes de salud, quien acudió a consulta por presentar dolor intenso de doce días de evolución localizado en el ojo derecho, asociado a pérdida de la visión, dolor a los movimientos oculares, astenia y anorexia. Al examen físico se encontró edema palpebral severo, abundantes secreciones mucopurulentas, quémosis conjuntival en 360 grados marcado e hiperemia cilio-conjuntival en el ojo derecho. Se realizaron estudios analíticos e imagenológicos. Al analizar el resultado de la exploración física y los complementarios se decidió la intervención quirúrgica consistente en la exenteración orbitaria derecha, esfenoidectomía y etmoidectomía transorbitaria derecha. Con una evolución satisfactoria fue egresada del centro hospitalario. La biopsia informó un melanoma coroideo. Conclusiones: El melanoma coroideo es una enfermedad ocular poco frecuente en mujeres jóvenes de piel negra. La sintomatología es extremadamente variable con las masas coroideas. Es importante conocer sus características, pues estos efectos clínicos sirven como un recordatorio para los oftalmólogos para incluirla en el diagnóstico diferencial de otras patologías oculares.

Introduction: Uveal melanoma is the most common intraocular cancer in adults, represents approximately 3 % to 5 % of all melanomas; with a peak incidence in men in the sixth decade of life. Objective : To describe the clinical presentation, diagnosis and treatment of a patient with uveal melanoma. Clinical case: A 39-year-old female patient, with a health history, who came to the consultation due to intense pain of twelve days of evolution located in the right eye, associated with loss of vision, pain with eye movements, asthenia and anorexy. Physical examination revealed severe palpebral edema, abundant mucopurulent secretions, marked 360-degree conjunctival chemosis, and cilio-conjunctival hyperemia in the right eye. Analytical and imaging studies were performed. When analyzing the results of the physical and complementary examination, the surgical intervention consisting of right orbital exenteration, sphenoidectomy and right transorbital ethmoidectomy was decided. With a satisfactory evolution, she was discharged from the hospital. Biopsy reported choroidal melanoma. Conclusions: Choroidal melanoma is a rare ocular entity in young black women. Symptomatology is extremely variable with choroidal masses. It is important to know its characteristics, since these clinical effects serve as a reminder for ophthalmologists to include it in the differential diagnosis of other ocular pathologies.

The pterional approach for the surgical resection of an orbital cholesteatoma: a case report.

BACKGROUND: Cholesteatomas are benign tumors mainly composed of cholesterol crystals that rarely arise within the orbit. However, orbital cholesteatomas require a complete surgical resection due to their recidivating potential. Transcranial approaches offering a broad surgical exposure of the orbital cavity have been scarcely used for the management of these tumors. Here, we provide evidence of the benefits of the pterional craniotomy for the surgical resection of orbital tumors by sharing our experience in the surgical management of a cholesteatoma of the superotemporal orbital wall. CASE PRESENTATION: A 45-year-old Hispanic man with a 2-year history of progressive proptosis of the left eye attended to our center complaining of diplopia and migraine. At his arrival, physical examination revealed ptosis, palpebral edema, and exophthalmos of the left eye, as well as the abolishment of the ipsilateral photomotor and consensual responses. Fundoscopy showed mild optic atrophy, whereas a T2-weighted magnetic resonance imaging (MRI) of the head showed a hyperintense mass arising at the superotemporal wall of the orbit that was displacing the eyeball. The tumor was resected using a pterional craniotomy without postoperative complications. The histopathological analysis of the tumor revealed a cholesteatoma. The patient recovered the functionality of the left eye with no visual sensitive deficits nor tumor recurrence 1 year after the surgery. CONCLUSIONS: Our results support the use of the pterional craniotomy as a safe procedure for the surgical resection of cholesteatomas arising at the superotemporal walls of the orbit, with low postoperative morbidity.

The clinical and pathogenic spectrum of surgically-induced scleral necrosis: A review.

The onset of scleral necrosis after ocular surgery may have catastrophic ocular and systemic consequences. The two most frequent surgeries causing surgically-induced scleral necrosis (SISN) are pterygium excision and cataract extraction. Several pathogenic mechanisms are involved in surgically induced scleral necrosis. All of them are poorly understood. Ocular trauma increasing lytic action of collagenases with subsequent collagen degradation, vascular disruption leading to local ischemia, and immune complex deposition activating the complement system represents some of the events that lead to scleral necrosis. The complex cascade of events involving different pathogenic mechanisms and the patient's abnormal immune response frequently leads to delayed wound healing that predisposes the development of scleral necrosis. The management of SISN ranges from short-term systemic anti-inflammatory drugs to aggressive immunosuppressive therapy and surgical repair. Therefore, before performing any ocular surgery involving the sclera, a thorough ophthalmic and systemic evaluation must be done to identify high-risk patients that may develop SISN.

Uso de resina acrílica no preenchimento de cavidade orbital após exenteração em um cão com hemangiossarcoma conjuntival / Use of acrylic resin to fill the orbital cavity after exenteration in a dog with conjunctival hemangiosarcoma

Background: The hemangiossarcoma (HSA) is a malignant tumor originated from the alterations of vascular endothelialcells. As it has an aggressive behavior, it is indicated, as initial treatment, wide surgical excision, such as the exenteration, which results in the surgical removal of the ocular bulb and adjacent tissues. The referred technique has as a resulta concave orbit and aesthetically unacceptable. Therefore, various materials, used as orbital implants, have been studiedand used in several species. Thus, it was aimed to report the use of the polymethylmethacrylate (PMMA) to fill the orbitalcavity after exenteration in a dog with conjunctival HSA.Case: A 10-year-old male Pitbull dog was assisted, with a clinical history of growth of a reddish tissue in the left eye, causingconstant hemorrhage, with an evolution of two months. At ophthalmic examination of the left eye, in the temporal bulbar conjunctive was found a reddish neoformation, with an irregular surface, measuring approximately 4 x 2 x 2 cm. The biopsy andaspiration cytology of the neoformation, revealed cells that inferred that they were those of conjunctival HSA. The hemogramrevealed normocytic anemia; the biochemical profile was with the standards of normality and no metastasis were found in theultrasonography and X-ray. The treatment of choice was the exenteration. Initially, the palpebral borders were approximatedusing continuous simple suture wit monofilament nylon thread. An incision was made in the skin, along the orbital rim andthen was performed a rhombus dissection of the conjunctive and all the extraocular muscles. Next, the eye globe, together withthe neoplasia, soft tissues of the orbital cavity and third eyelid were removed. The PMMA was obtained from a mixture of thepowder (polymer) and of the liquid (monomer) in the ratio of 1:1 in a sterile recipient, in...(AU)

Uso de resina acrílica no preenchimento de cavidade orbital após exenteração em um cão com hemangiossarcoma conjuntival / Use of acrylic resin to fill the orbital cavity after exenteration in a dog with conjunctival hemangiosarcoma

Background: The hemangiossarcoma (HSA) is a malignant tumor originated from the alterations of vascular endothelialcells. As it has an aggressive behavior, it is indicated, as initial treatment, wide surgical excision, such as the exenteration, which results in the surgical removal of the ocular bulb and adjacent tissues. The referred technique has as a resulta concave orbit and aesthetically unacceptable. Therefore, various materials, used as orbital implants, have been studiedand used in several species. Thus, it was aimed to report the use of the polymethylmethacrylate (PMMA) to fill the orbitalcavity after exenteration in a dog with conjunctival HSA.Case: A 10-year-old male Pitbull dog was assisted, with a clinical history of growth of a reddish tissue in the left eye, causingconstant hemorrhage, with an evolution of two months. At ophthalmic examination of the left eye, in the temporal bulbar conjunctive was found a reddish neoformation, with an irregular surface, measuring approximately 4 x 2 x 2 cm. The biopsy andaspiration cytology of the neoformation, revealed cells that inferred that they were those of conjunctival HSA. The hemogramrevealed normocytic anemia; the biochemical profile was with the standards of normality and no metastasis were found in theultrasonography and X-ray. The treatment of choice was the exenteration. Initially, the palpebral borders were approximatedusing continuous simple suture wit monofilament nylon thread. An incision was made in the skin, along the orbital rim andthen was performed a rhombus dissection of the conjunctive and all the extraocular muscles. Next, the eye globe, together withthe neoplasia, soft tissues of the orbital cavity and third eyelid were removed. The PMMA was obtained from a mixture of thepowder (polymer) and of the liquid (monomer) in the ratio of 1:1 in a sterile recipient, in...

Characteristics of Sympathetic Ophthalmia in a Single International Center.

AIM: To report the main features of sympathetic ophthalmia in a referral ophthalmology center. METHODS: Retrospective clinical study. We reviewed clinical records of patients with diagnosis of sympathetic ophthalmia attending the Uveitis Department from 2007 to 2013. Patients were selected by clinical criteria. Descriptive statistics were used to assess variables. RESULTS: Twenty patients were included for analysis, 13 males and 7 females. Mean follow up was 1 year. The median age of presentation was 50 years. Fifty percent had history of ocular trauma and 50% had history of intraocular surgery, of which 40% underwent phacoemulsification. The time between injury and onset of symptoms ranged from 1 to 456 months. Most common ocular manifestations were mutton fat keratic precipitates and anterior chamber inflammation. All patients received oral prednisone as single or combined therapy. Sixty percent of the sympathizing eyes improved two or more lines of vision and 20% lost two or more lines of vision. CONCLUSION: This report from a single center adds to the body of literature of sympathetic ophthalmia occurring in a specific population. Our data found a high proportion of patients with sympathetic ophthalmia after phacoemulsification.

Evaluación prospectiva de la combinación colirio-ungüento de ciprofloxacino-dexametasona y tobramicina-dexametasona en cirugía de catarata / Prospective evaluation of eye drops and ointments of ciprofloxacin/dexamethasone versus tobramycin/dexamethasone combinations in ocular surgery

El uso profiláctico de antibióticos y antiinflamatorios post cirugía oftálmica es una práctica común. La tobramicina es aminoglicósido con espectro de gram negativos y alguns gram positivos. Ciprofloxacino tiene un mayor espectro. Objetivo: Comparar la eficacia y seguridad de la combinación colirio y ungüento de cirpofloxacino/dexametasona versus tobramicina/dexametasona. Pacientes y métodos: Se estudio en forma randomizada y doble ciego, 64 pacientes durante 15 días. Se realizaron 3 controles donde se registró agudeza visual, presión intraocular y una escala subjetiva y objetiva. Resultados: 60 pacientes completaron el estudio. El prurito fue menor en el grupo tratado con ciprofloxacino (0.26 v/s 0.47; p<0,05). Conclusiones: El estudio demostró eficacia y seguridad antibiótica equivalente entre ambas combinaciones. Considerando el mayor espectro antibacteriano de ciprofloxacino y la menor incidencia de prurito se plantea que el uso de esta combinación en pacientes post cirugía de catarata entregaría una protección antibiótica segura y con espectro más amplio.

The prohylactic use of antibiotics and anti-inflammatories drugs is a common practice in ophthalmic surgery. Tobramycin is an aminoglycoside with gram negative spectrum, covering some gram positive bacteria. Ciprofloxacin has a broader spectrum of effectivity. Purpose: To compare effectiveness and safety of eye drops and ointments of ciprofloxacim/dexamethasone versus tobramysin/dexamethasone combinations. Patients and methods: Random and doubled masked study, performed in 64 patients who had cataract surgery. In a 15 days follow up, the effectiveness of both antibiotic combinations were tested. Visual acuity, intraocular pressure, objective and subjective scale were performed. Results: 60 patients (93.4 percent) completed the follow up. Itching presented a significant difference between both groups, being lower in the ciprofloxacin/dexamethasone combination (0.26 vs 0.47. p<0.05). Conclusions: The study shows an equivalent effectiveness and safety of both antibiotic combinations. Considering the broader spectrum of ciprofloxacin and the lower frequency of itchness, ciprofloxacin/dexamethasone combination seems to be a good choice for post operative treatment in cataract surgery.

Clinical and histologic study of autogenous oral mucosa in experimental lamellar ketatoplasty / Estudo clínico e histológico da mucosa oral autógena na ceratoplastia lamelar experimental

Eight male dogs of non-specified breed, weighing about 12,4 kg, were subjected to surgical oral mucosa detachment using among others a 5 mm diameter trepan followed by it fixation on 4,5 mm diameter corneal lesion made in an eye, using 9-0 nylon thread in interrupted simple suture pattern. The animals were divided to 4 groups constituted by 2 animals, for histologic study at 15, 30, 45, 60 days of post surgical phase. Meanwhile, clinical findings such as blepharospasm, opacity, neovascularization, ocular discharge, chemosis and characteristics of the graft (vascularization, pigmentation and adhesiveness), were qualitative and quantitatively evaluated at 0-2 days, 3-7 days, 8-15 days, 16-30 days and 31-60 days of postoperative period. Blepharospasm and chemosis were more intense at initial periods, corneal opacity and vascularization (of cornea and grafts) at intermediate periods, both with regressing tendency on the latest periods. Serous mucous exsudate was predominant in higher degrees at the initial and intermediate phases and was absent on the later phases. Clinically, the integration of the graft was verified at 15th day. Pigment deposition was seen on two animals on the later periods. The microscopic study revealed on initial and intermediate periods a thick epithelium in comparasion with the underlying cornea, with vacuolization of the inmost cells, intense fibroplasia a

Oito cães sem raça definida, machos, com peso corpóreo médio de 12,4 kg, foram submetidos a procedimentos cirúrgicos de retirada de fragmento da mucosa oral com auxílio de trépano de 5 mm com posterior aplicação sobre lesão corneana de 4,5 mm de diâmetro, produzida em um dos olhos, aplicando-se sutura simples interrompida com fio de náilon 9-0. Os animais foram divididos em 4 grupos compostos por 2 animais, para estudo histológico aos 15, 30, 45, 60 dias de pós-operatório. Simultaneamente, realizou-se estudo clínico nos períodos de 0-2 dias, 3-7 dias, 8-15 dias, 16-30 dias e 31-60 dias de pós-operatório. Blefarospasmo e quemose foram mais intensos nos períodos iniciais e opacidade corneana e vascularização (da córnea e enxerto) nos períodos intermediários, ambos com tendência de regressão nos períodos tardios. A secreção predominante foi seromucosa, sendo mais incidente nas fases iniciais e intermediárias com ausência nos tardios. Clinicamente, a integração do enxerto foi verificada no 15º dia. O estudo microscópico revelou para os períodos iniciais e intermediários intensa fibroplasia e deposição de fibras colágenas em arranjo desorganizado e vascularização do enxerto de intensa a leve entre 15º e 30º dia. Infiltrado polimorfonuclear foi observado no 15º dia, em grau discreto. Infiltrado linfoplasmocitário foi predominantemente, em grau discreto a moderado, entre o 30º e 60º d

Clinical and histologic study of autogenous oral mucosa in experimental lamellar ketatoplasty / Estudo clínico e histológico da mucosa oral autógena na ceratoplastia lamelar experimental

Eight male dogs of non-specified breed, weighing about 12,4 kg, were subjected to surgical oral mucosa detachment using among others a 5 mm diameter trepan followed by it fixation on 4,5 mm diameter corneal lesion made in an eye, using 9-0 nylon thread in interrupted simple suture pattern. The animals were divided to 4 groups constituted by 2 animals, for histologic study at 15, 30, 45, 60 days of post surgical phase. Meanwhile, clinical findings such as blepharospasm, opacity, neovascularization, ocular discharge, chemosis and characteristics of the graft (vascularization, pigmentation and adhesiveness), were qualitative and quantitatively evaluated at 0-2 days, 3-7 days, 8-15 days, 16-30 days and 31-60 days of postoperative period. Blepharospasm and chemosis were more intense at initial periods, corneal opacity and vascularization (of cornea and grafts) at intermediate periods, both with regressing tendency on the latest periods. Serous mucous exsudate was predominant in higher degrees at the initial and intermediate phases and was absent on the later phases. Clinically, the integration of the graft was verified at 15th day. Pigment deposition was seen on two animals on the later periods. The microscopic study revealed on initial and intermediate periods a thick epithelium in comparasion with the underlying cornea, with vacuolization of the inmost cells, intense fibroplasia a

Oito cães sem raça definida, machos, com peso corpóreo médio de 12,4 kg, foram submetidos a procedimentos cirúrgicos de retirada de fragmento da mucosa oral com auxílio de trépano de 5 mm com posterior aplicação sobre lesão corneana de 4,5 mm de diâmetro, produzida em um dos olhos, aplicando-se sutura simples interrompida com fio de náilon 9-0. Os animais foram divididos em 4 grupos compostos por 2 animais, para estudo histológico aos 15, 30, 45, 60 dias de pós-operatório. Simultaneamente, realizou-se estudo clínico nos períodos de 0-2 dias, 3-7 dias, 8-15 dias, 16-30 dias e 31-60 dias de pós-operatório. Blefarospasmo e quemose foram mais intensos nos períodos iniciais e opacidade corneana e vascularização (da córnea e enxerto) nos períodos intermediários, ambos com tendência de regressão nos períodos tardios. A secreção predominante foi seromucosa, sendo mais incidente nas fases iniciais e intermediárias com ausência nos tardios. Clinicamente, a integração do enxerto foi verificada no 15º dia. O estudo microscópico revelou para os períodos iniciais e intermediários intensa fibroplasia e deposição de fibras colágenas em arranjo desorganizado e vascularização do enxerto de intensa a leve entre 15º e 30º dia. Infiltrado polimorfonuclear foi observado no 15º dia, em grau discreto. Infiltrado linfoplasmocitário foi predominantemente, em grau discreto a moderado, entre o 30º e 60º d