Angiosarcoma of the eyelid

Background: Angiosarcomas are uncommon malignant tumours of vascular endothelium. They frequently affect the face and scalp, but to our knowledge there are only three reports of eyelid involvement.
Methods/results: We report a case of angiosarcoma arising from the eyelid skin in a 79-year-old woman. Treatment was surgical with wide excision and staged reconstruction of the defect. Systemic oncological work-up for metastatic disease was negative. Adjuvant systemic chemotherapy and radiotherapy were considered but were not felt to be of proven benefit and were not used. The patient died seven months after presentation from a myocardial infarct.
Conclusion: Angiosarcoma should be considered in the differential diagnosis of unusual or atypical eyelid lesions. Management is wide surgical excision, although adjuvant systemic therapy should be considered in selected cases in consultation with an oncologist.     

Treatment of orbital capillary haemangioma with interferon

Background: Capillary haemangiomas are vascular tumours of childhood characterised by proliferative and involutional phases and affecting 1% to 2% of newborns. Recently, recombinant interferons have been used in the treatment of life and sight threatening complications of these tumours. Methods: The history, results of examination, investigations, management and outcome of two patients with sight-threatening orbital capillary haemangiomas treated with recombinant interferon alpha-2a and 2b respectively were reviewed. Results: Orbital and systemic lesions displayed good response to interferons. Side effects noted were transient pyrexia and elevated serum aminotransferase levels. Disturbed liver function test results occurred in one case and normalised with temporary cessation of therapy. Conclusions: The interferons are a useful alternative treatment of orbital capillary haemangioma in selected cases.     

Isolated bulbar conjunctival Kaposi's sarcoma

We present a case of an isolated bulbar conjunctival Kaposi's sarcoma in a man with HIV infection. This is an unusual site for the initial presentation of Kaposi's sarcoma and in this site can be confused with a caroticocavernous fistula, cavernous haeman-gioma or chronic subconjunctival haemorrhage. Biopsy is required to confirm the diagnosis in isolated disease. Local radiotherapy is the preferred treatment for isolated Kaposi's sarcoma.     

Haemophilus aphrophilus bleb infection after a mitomycin trabeculectomy

Background: Haemophilus aphrophilus is a rare cause of ocular infection. It has been reported once as a cause of late-onset endophthalmitis in a patient with an inadvertent bleb after cataract surgery. We present a case of Haemophilus aphrophilus bleb infection after a mitomycin trabeculectomy.
Methods: A 56-year-old woman presented with a bleb infection 10 weeks after a mitomycin C augmented trabeculectomy at a University tertiary referral practice of one of the authors (GET). The causative organism was Haemophilus aphrophilus , identified by the Toronto Public Health Laboratory, Ontario, Canada.
Results: The bleb infection resolved following topical, subconjunctival and intravenous antibiotic therapy. A formal bleb revision was required to repair a persistent bleb leak.
Conclusion: Patients who have had trabeculectomies augmented with mitomycin C may be predisposed to bleb infection with unusual organisms. Prompt diagnosis and treatment is necessary to control the infection. Increased awareness and communication with laboratory personnel may increase the isolation of this fastidious organism.     

热休克反应对大鼠视网膜缺血再灌注损伤的防御作用

目的 观察热休克反应对大鼠视网膜缺血再灌注损伤的防御作用。 方法 将20只Wistar大鼠20只眼随机分为4组，每组5只大鼠。行前房灌注（perfusion）平衡盐溶液制造急性高眼压模型,为高眼压组(P组)；在制造急性高眼压模型前24 h向大鼠腹腔内注射槲皮素(quercetin) (400 mg/kg)，为高眼压＋槲皮素组(P+Q组)；在制造急性高眼压模型前24 h 热休克(heat shock)大鼠，为高眼压＋热休克组(P+H组)；分别在制造急性高眼压模型前48 、24 h，向大鼠腹腔内注射槲皮素、热休克大鼠，为高眼压＋槲皮素+热休克组(P+Q+H组) 。按照国际临床视觉电生理学会的标准化方案，采用国特医疗系统对热休克反应后实验性高眼压大鼠模型和HSP70被槲皮素特异性抑制后实验性高眼压大鼠模型进行暗适应视网膜电图(dark adapted electroretinogram, D-ERG)、振荡电位(oscillatory potentials, OPs)和明适应E RG(light adapted ERG, L-ERG)记录。采用Western blotting方法检测各组大鼠视网膜HSP 70表达情况。 结果 P+H组大鼠视网膜HSP70表达在各组大鼠中最高，P+Q、P+Q+H组大鼠视网膜HSP70表达受到抑制。前房灌注后各组大鼠ERG各波潜伏期延长、幅值减小，P+H组D-ERG的b波、OPs的O₂波的幅值较P组高。灌注0 h后，P+H组各波幅值显著增高(P值均<0.05)；灌注24 h 后，P+H组大鼠视网膜功能恢复较P组好。P+Q、P+Q+H组大鼠灌注后ERG各波及OPs的O₂波潜伏期最长，幅值最低，甚至消失。 结论 热休克反应可以提高大鼠视网膜细胞对缺血再灌注损伤的防御作用。 （中华眼底病杂志，2003，19：117-120）     

EVEREST STUDY: Efficacy and Safety of Verteporfin Photodynamic Therapy in Combination with Ranibizumab or Alone Versus Ranibizumab Monotherapy in Patients with Symptomatic Macular Polypoidal Choroidal Vasculopathy

PURPOSE:: To assess the effects of verteporfin photodynamic therapy (PDT) combined with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. METHODS:: In this multicenter, double-masked, primarily indocyanine green angiography-guided trial, 61 Asian patients were randomized to verteporfin PDT (standard fluence), ranibizumab 0.5 mg, or the combination. Patients were administered with verteporfin PDT/placebo and initiated with three consecutive monthly ranibizumab/sham injections starting Day 1, and re-treated (Months 3-5) as per predefined criteria. The primary endpoint was the proportion of patients with indocyanine green angiography-assessed complete regression of polyps at Month 6. Secondary endpoints included mean change in best-corrected visual acuity at Month 6 and safety. RESULTS:: At Month 6, verteporfin combined with ranibizumab or alone was superior to ranibizumab monotherapy in achieving complete polyp regression (77.8% and 71.4% vs. 28.6%; P < 0.01); mean change ± standard deviation in best-corrected visual acuity (letters) was 10.9 ± 10.9 (verteporfin PDT + ranibizumab), 7.5 ± 10.6 (verteporfin PDT), and 9.2 ± 12.4 (ranibizumab). There were no new safety findings with either drug used alone or in combination. CONCLUSION:: Verteporfin PDT combined with ranibizumab 0.5 mg or alone was superior to ranibizumab monotherapy in achieving complete regression of polyps in this 6-month study in patients with symptomatic macular polypoidal choroidal vasculopathy. All treatments were well tolerated over 6 months.