What to think of "adjuvant" or "neoadjuvant" thermotherapy in the treatment of uveal melanomas?

Before 810Nm laser thermotherapy has been usd for uveal melanoma, several authors especially in Essen (Germany) were asking themselves about the possibilities of xenon arc or argon laser effects on uveal melanomas. High rates of recurrences due to the non penetration of therapeutic light till the sclera had led to the conception of using adjuvant thermotherapy associated with radiotherapy, through microwaves, ultrasounds or ferromagnetic seeds. In Leyden (Netherlands) was proposed the use of 810Nm laser diode initially as an adjuvant to radiotherapy and later on as primary isolated treatment ("neo adjuvant" TTT), especially for small tumours located in the posterior pole (juxta-papillary tumours). TTT used alone should not be proposed for tumours of inital height of more than 3,5 to 4mm. "Neo adjuvant" thermotherapy finds some other indications like decompensated naevi responsible for macular detachment. Bigger peripheral tumours stabilized by protonbeam therapy but associated with persistent detachment after the 12(th) month could be treated with "adjuvant" TTT. Finally the importance of the quality of the tumour edges treatment should be emphasized.     

The ophthalmologist B. Adamandiadis and the history of the "Adamandiadis-Beh?et syndrome"

This article presents the scientific and social work of Benedikt Adamandiadis and the history of the "Adamandiadis-Beh?et syndrome". The authors also attempt to describe the inestimable contribution to modern Greek ophthalmology. It is not the authors' intention to underscore Adamandiadis' importance as the discoverer of the syndrome - for him, the fulfillment of his duties as a scientist and a human being was always more important than personal fame -, but merely to correct an historical injustice.     

Facial dysmorphopsia: a notable variant of the "thin man" phenomenon?

Background

The aim of this work is to investigate the facial distortion (dysmorphopsia) experienced by patients with homonymous paracentral scotomas and to analyze the interrelationship with the previously described “thin man” phenomenon.

Methods

Routine neuro-ophthalmological examination and brain MRI in three patients who suffered from small homonymous paracentral scotomas due to infarction or arteriovenous malformations of the occipital lobe. They all complained of distortion and shrinkage of their interlocutor’s face contralateral to the brain lesion. The phenomenon appeared some seconds after steady fixation on the interlocutor’s nose and was evident with both left and right homonymous scotomas. The patients did not notice a gap in the area corresponding to the scotoma and objects other than faces were perceived normally.

Results

Homonymous paracentral scotomas can lead to focal displacement of facial features towards the center of the field defect with resulting distortion of the face on the affected side. This so-called “dysmorphopsia” makes faces appear regionally narrower than they are in reality and may be induced even by visual field defects that remain undetected by conventional perimetry using 6° × 6° grids. Predilection for faces is probably associated with the superior location of scotomas or specific impairment of face processing abilities related to the lesion site.

Conclusions

Facial dysmorphopsia is most probably associated with cortical “filling-in” and spatial distortion, and can hence be regarded as a special entity of the “thin man” phenomenon.     

Analysis of the causes of enucleations performed at the Department of Ophthalmology of the Medical University of Lódź

PURPOSE: To gather and analyse the data about causes of enucleations, which were performed in the Department of Ophthalmology, Medical University of Lód?. MATERIAL AND METHODS: The data were based on case histories. The whole examined group consisted of 57 patients, who had an enucleation surgery done in the period from June 1999 to June 2003. The analyzed data included: clinical diagnosis, visual acuity, intraocular pressure, results of histopathology examination and results of diagnostic imaging examinations. RESULTS: The most frequent causes of enucleations were: intraocular tumors (fraction 0.51 of the whole group), painful blind eyes (fraction 0.33), endophthalmitis (fraction 0.12) and ocular traumas (fraction 0.04). CONCLUSIONS: Despite significant advances in ophthalmology in recent years, enucleation remains a method of treatment. The main indications for this type of surgery are: intraocular tumors, painful blind eyes, severe endophthalmitis and some cases of ocular trauma.     

Is the partial pressure of carbon dioxide in the blood related to the development of retinopathy of prematurity?

AIMS: To determine the role of carbon dioxide in the development of retinopathy of prematurity (ROP). METHODS: This was a retrospective cohort study of 25 consecutive infants admitted to the neonatal unit with continuously recorded physiological data. The daily mean and standard deviation (SD) of transcutaneous carbon dioxide partial pressure (tcPCO(2)) was compared between infants who had stage 1 or 2 ROP and stage 3 ROP. The time spent hypocarbic (<3 kPa) and/or hypercarbic (>10 kPa and >12 kPa) was also compared between these groups. Intermittent arterial carbon dioxide tension was also measured and compared with the simultaneous tcPCO(2) data. RESULTS: There were no significant differences in carbon dioxide variability or time spent hypocarbic and/or hypercarbic between the ROP groups on any day. 86% of transcutaneous values were within 1.5 kPa of the simultaneous arterial value. CONCLUSION: TcPCO(2) measurement can be a very useful management technique. However, in this cohort neither variable blood carbon dioxide tension nor duration of hypercarbia or hypocarbia in the first 2 weeks of life was associated with the development or severity of ROP.     

Review of the treatment of Graves’ ophthalmopathy: The role of the new radiation techniques

Graves ophthalmopathy (GO) is an autoimmune disorder and the most frequent extrathyroidal manifestation of Graves’ disease. GO is an inflammatory process leading to an increased volume of the extraocular muscles and orbital connective and adipose tissues associated with multiple histopathological changes. Despite recent progress in the understanding of its pathogenesis, GO often remains a major diagnostic and therapeutic challenge. It has become increasingly important to classify patients into categories based on disease severity and activity. Low doses of radiotherapy (RT) have demonstrated a benefit in the treatment of moderate-to-severe GO with very few side effects. New RT techniques deliver a more conformal dose distribution to the target and decrease the dose to normal healthy tissue minimizing the risk of side effects. In this review we briefly analyzed the pathogenesis of GO and discussed the most relevant therapeutic approaches, with particular emphasis in the new RT technics. Appropriately designed and powered clinical studies are necessary to determine the most effective treatment with the lowest risk of side effects.     

Review of the Series “Disease of the Year 2011: Toxoplasmosis” Pathophysiology of Toxoplasmosis

Toxoplasma gondii is a major cause of chronic parasitic infection in the world. This protozoan can cause retino-choroiditis in newborns and in adults, both immunocompetent and immunodeficient. This disease tends to be recurrent and can lead to severe visual impairment. The authors review current knowledge on the role of parasite genetics in influencing susceptibility to ocular toxoplasmosis and on the immuno-pathogenesis of this disease.     

Does identification of the causal organism of corneal ulcers influence the outcome?

PURPOSE: To investigate whether identification of the causal organism in corneal ulcers influences their outcome. METHODS: We retrospectively studied 114 patients, 72 males and 42 females aged 6-89 years, admitted to this eye clinic during the years 1994-2000 on account of an infectious corneal ulcer. Their examination included a detailed history, visual acuity measurement, and biomicroscopy in everyday follow-up. The ulcers were classified according to their severity and outcome. We assessed the cases where cultures had been done, reviewed the results, and searched for a possible correlation between the outcome and the fact of culturing the ulcer and identifying the causal organism. RESULTS: Of the 114 corneal ulcers studied, 23 were mild, 49 moderate, and 42 severe. Fifty (44%) had not been cultured, but 64 ulcers (56%) had been cultured, with a positive result in 37 cases (58%), Staphylococcus and Pseudomonas species being the most common organisms found. In moderate and severe ulcers, there was a tendency to a higher proportion of successful outcome for cultured ulcers, but with no significant correlation. CONCLUSIONS: Despite a tendency towards favorable results in culture-positive corneal ulcers, the influence of the detection of the organism on their outcome has not been proved. The role of the initial broad-spectrum antibiotic therapy remains important.