Blepharophimosis ptosis epicanthus inversus syndrome (BPES) (corrected)

The blepharophimosis ptosis epicanthus inversus syndrome (BPES, also known as Waardenburg syndrome) was probably first reported by Ammon in 1841 and discribed more fully by Vignes in 1889. Its primary effects on the soft tissue of the midface are blepharophimosis, ptosis, epicanthus inversus and telecanthus. It starts with the epicanthic folds at about the age of 3-4 years, followed by the correction of the ptosis about 9-12 months later. Early surgery may be necessary for amblyopia. In 1995 the gene locus was identified as 3Q23. BPES is due to a mutation within a single gene, the FOXL2 gene. In female patients an early childhood ovarian insufficiency must be excluded.     

Minimal intensity diode laser (810 nanometer) photocoagulation (MIP) for diffuse diabetic macular edema (DDME)

BACKGROUND AND OBJECTIVE: To determine the effectiveness of minimal intensity diode laser (810nm) photocoagulation (MIP) for diffuse diabetic macular edema (DDME). METHODS: Patients demonstrating diffuse diabetic macular edema (DDME) were treated with minimal intensity diode 810 laser photocoagulation or modified grid photocoagulation consecutively. Patients were seen and reevaluated at regular follow up visits every 3 to 4 months and retreated if residual diffuse diabetic macular edema was still present. Selected patients were tested with Goldmann visual field, pre and post-treatment. Visual improvement, visual loss, visual field, reduction/elimination of macular edema, and a number of treatments were studied. RESULTS: Reduction/elimination of DDME was observed in approximately 74% of eyes with 24 months follow up. The number of treatments per eye ranged from 1 to 5. The presence of cystoid macular edema, initial poor visual acuity, the presence of coexisting macular ischemia, or a history of systemic hypertension did not effect the outcome. Patients without a history of systemic vascular disease had a better chance of visual stabilization or improvement compared to those patients with a history of systemic vascular disease. Eighty-eight percent of patients had at least stable visual acuity at the last follow up visit. No post-treatment subjective complaints of increased pericentral scotomas were encountered in this group of patients and post-treatment atrophic scarring was substantially reduced, by using minimal intensity diode laser 810 photocoagulation, compared to eyes previously treated with shorter wavelengths and more visible burns. CONCLUSION: Minimal intensity diode laser 810nm modified grid laser photocoagulation for diffuse diabetic macular edema (DDME) is effective in reducing/eliminating DDME, although resolution of edema may be slightly prolonged and may require 1 or 2 additional treatments compared to eyes previously treated with shorter wavelengths and more visible burns. However, this method appears to be advantageous in that it appears to reduce the objective and subjective effect on the pericentral visual field, as well as substantially reducing the post-treatment atrophic scarring seen in patients treated with shorter wavelength lasers and move visible burns.     

External (subciliary) vs internal (transconjunctival) involutional entropion repair

PURPOSE: To compare surgical outcomes of internal (transconjunctival) vs external (subciliary) involutional entropion repair. DESIGN: Retrospective, consecutive case series. METHODS: Electronic medical record review of all patients who underwent involutional entropion repair at the Jules Stein Eye Institute over a 4-year period was performed. MAIN OUTCOME MEASURES: Anatomic and functional success, recurrence rate, and complications. RESULTS: Forty-nine eyes (39 patients) were operated. Twenty-nine eyes underwent subciliary incision repair; 20 eyes underwent transconjunctival repair, both with lower lid retractors reinsertion. Good correlation was found between two masked observers in grading surgical outcome (on a scale of 1 to 4) (r = .76, P < .001). Forty-two cases (84%) achieved good surgical repair and improvement in symptoms. Recurrence was noticed in 4 eyes (8.2%). Recurrence was higher with the internal approach (15% vs 3% with subciliary incision), but this was not statistically significant (P = .14). Complications included: three cases (8.2%) with mild eyelid retraction that were treated conservatively, three cases with postoperative ectropion (all in the external approach, two of which lateral canthal resuspension was not performed), and two cases (4.1%, one case in each group) with pyogenic granuloma. CONCLUSIONS: Surgical correction of involutional entropion by reinsertion of lower eyelid retractors has similar outcome with internal (transconjunctival) and external (subcilliary) approaches. Although not statistically significant, internal repair may result in a higher recurrence rate, whereas external repair may show more postoperative ectropion, most probably attributable to scarring of the anterior lamella. Lateral canthal resuspension, when needed, may reduce the rate of postoperative ectropion.     

Oxyphil-cell adenoma (oncocytoma) of the caruncle (author's transl)

By histological examination of 42 caruncle tumors we found 5 oncocytomas. All the patients were women older than 63 years. The clinical and histological findings are described and the pathogenesis of these tumors discussed.