Journal Contents
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Ophthalmic Plastics and Reconstructive SurgeryNeurotrophic and Anhidrotic Keratopathy Treated with Substance P and Insulinlike Growth Factor 1 Brown et al Arch Ophthalmol. 1997 Jul;115(7):926-7
PATIENT'S CORNER: CLINICIAN'S CORNER: Substance P has been shown to be mitogenic for corneal epithelial cells in vitro. Synergy occurs when other growth factors are added such as IGF-1. IGF-1 alone did not promote mitotic activity in the authors' laboratory. Subepithelial neurons secreting substance P are in high concentration in the normal animal and thus presumably human eye. Destruction of the trigeminal nerve is well known to result in neurotrophic lesions. The concentration of substance P is reduced. This patient had bilateral central defects and stromal melting. A descemetocele developed in the right eye and was treated by a Gunderson flap. Empiric concentrations of substance P were applied for ten days with no effect. IGF-1 was added to the mixture given as drops to the left eye. Healing was seen in 5 days and complete in 30 days. Maintenance preservative free drops alone were used after epithelialization had occurred. The right eye underwent a PKP through the Gunderson flap with postoperative SP and IGF-1 therapy. It epithelialized and remained clear. My personal regimen in these cases was to proceed to a tarsorraphy early on. Although this tried and true technique can have a dramatic effect, the addition of an effective medical therapy would be considerably more appealing to all involved.
Ophthalmic Plastics and Reconstructive SurgeryMortality on Patients with Small Choroidal Melanoma: COMS Report No. 4 The Collaborative Ocular Melanoma Study Group Arch Ophthalmol 1997;115:886-893
Patient's Corner: Clinician's Corner: METHODS: Eight COMS study centers participated in a sub study of patients with small melanomas. 204 patients were enroled with 80 being considered inelegible because of the presence of metastases, previous treatment, significant involvement of the ciliary body, another malignacy, multi-focal lesions, serious comorbid conditions, less than 21 years old and for presumed inability to follow through the study. RESULTS: 28%of all lesions from the reporting centers were "small". 204 patients were enrolled. All but one were white. Mean height was 2.3 mm. Mean basal diameter was 7.6 mm. 16 elegiblepatients did not enroll in the study. 8% were treated prior to enrollment. 67 (33%) were treated during the study: 32 with radioactive plaque therapy, 26 by enucleation and the remaining 9 by varied techniques including proton beam, laser photocoagulation and photon irradiation. Some of these treatments were done as part of the medium and large COMS study because the lesions grew making them eligible for this study. 204 Patients
Apparent risk factors for worse outcome:
Ophthalmic Plastics and Reconstructive SurgerySilicone punctal plug migration resulting in dacryocystitis and canaliculitis. Rumelt S, Remulla H, Rubin PA Cornea 1997 May;16(3):377-379 PURPOSE: One of the modalities of treating dry eyes is punctal plugs. They are usually used for temporary occlusion of the lacrimal drainage system. Among the complications associated with silicone punctal plugs are extrusion, downward migration, irritation, and epiphora. To our knowledge, this is the first report of dacryocystitis and canaliculitis as a result of spontaneous migration of punctal plugs into the lacrimal drainage system. METHODS: We describe the sequelae of spontaneous migration of silicone punctal plugs into the lacrimal drainage system in two patients with dry eyes. RESULTS: In two patients, spontaneous migration of silicone punctal plugs into the canaliculus or the lacrimal sac, respectively, resulted in canaliculitis or dacryocystitis. CONCLUSION: Smaller sized newer generation punctal plugs were designed to facilitate insertion; however, this design also increases the likelihood of proximal migration within the lacrimal drainage system. The importance of monitoring patients after punctal-plug placement cannot be over-emphasized.
Ophthalmic Plastics and Reconstructive SurgeryA Gene For Isolated Congenital Ptosis Maps To A 3-Cm Region Within 1p32-p34.1 Engle EC; Castro AE; Macy ME; Knoll JH; Beggs AH Am J Hum Genet 1997 May;60(5):1150-7 Hereditary isolated congenital ptosis is an autosomal dominant disorder with incomplete penetrance characterized by a variable degree of unilateral or bilateral drooping of the upper eyelids. We report linkage of this disorder in a large family to markers on chromosome 1p. In our sample of 37 meioses, nine informative markers did not recombine with the disease. D1S2677 gave a maximum two-point LOD score of 8.8 on the assumption of 90% penetrance (theta = 0). D1S447/2733 and D1S1616 flank the disease locus, with two-point LOD scores of 5.6/6.6 (theta = .04) and 4.9 (theta = .05), respectively, defining a region of 2.8 cM. FISH of YACs containing flanking recombinant markers localizes the gene to chromosome 1p32-p34.1. These data establish a map location for an isolated congenital ptosis gene and demonstrate that this disorder is genetically distinct from other extraocular muscle-specific disorders such as congenital fibrosis of the extraocular muscles and blepharophimosis.
Ophthalmic Plastics and Reconstructive SurgeryDacryocystorhinostomy with Intraoperative Mitomycin C Kao et al Ophthalmology 1997;104:86-91 The authors used 400 micrograms per ml Mitomycin C soak cottonoids for 30 minutes on seven eyes. Eight eyes served as controls. They then photographed the internal ostomies via endoscopy immediately postop, and at 1,3 and 6 months postoperatively. A blinded observer calculated the size of the ostomies in every photograph. RESULTS:
If these results hold true on retesting with a much larger sample size, MMC will become routine in DCR surgery. It improves success rates. Time will tell if the larger ostomies cause more problems - this may be an unwanted side effect of MMC use. In addition, the serious complications noted with the use of MMC in other ophthalmic conditions such as ptyerigium and glaucoma surgery are severe enough to warrant caution when considering this technique. Possibly a lower dose or duration of application? First a randomized control, prospective study, similar to the current one but with a much larger sample size should be undertaken to validate the effectiveness of mitomycin C in external DCR surgery.
Ophthalmic Plastics and Reconstructive SurgeryUnusual Skin Depigmentation Following Eyelid Cryosurgery Zabriskie NA. Nordlund JJ. Nerad JA. Ophthalmic Plastic & Reconstructive Surgery. 12(4):296-298, 1996 Dec A 71-year-old African-American man was treated with cryosurgery of the left lower for trichiasis. Dramatic depigmentation of the lid skin followed, including substantial pigment loss on the untreated upper lip. Pigmentation returned to nearly normal over a 9-year period. Depigmentation of the skin following cryosurgery is a well-known complication. The clinical course of the depigmentation, however, is not well demonstrated in the literature. This case documents, with clinical photographs, the spontaneous return to nearly normal pigmentation 9 years following the cryosurgery. In addition, the extensive depigmentation seen in this patient cannot be explained by cryoinjury alone. We speculate that the depigmentation was due, in part, to segmental vitiligo initiated at the site treated with cryosurgery.
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