Oculoplastic aspects of ocular oncology

It is estimated that 5-10% of all cutaneous malignancies involve the periocular region and management of periocular skin cancers account for a significant proportion of the oculoplastic surgeon's workload. Epithelial tumours are most frequently encountered, including basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma, in decreasing order of frequency. Non-epithelial tumours, such as cutaneous melanoma and Merkel cell carcinoma, rarely involve the ocular adnexae. Although non-surgical treatments for periocular malignancies are gaining in popularity, surgery remains the main treatment modality and has as its main aims tumour clearance, restoration of the eyelid function, protection of the ocular surface, and achieving a good cosmetic outcome. The purpose of this article is to review the management of malignant periocular tumours, with particular emphasis on surgical management.

Major orbital complications of endoscopic sinus surgery

BACKGROUND

The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss.

METHODS

A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery.

RESULTS

All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply.

CONCLUSION

Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed.

Immunohistochemical and cytokine analysis of eyes from rats with adjuvant arthritis

Adjuvant induced arthritis in the rat is an animal model of juvenile chronic arthritis (JCA). An anterior uveitis may also develop in this model which closely resembles that seen in association with JCA in the human. Female Lewis rats (150-225 g) were injected intradermally with either Freund's complete adjuvant (FCA, n=5) or Freund's incomplete adjuvant (FIA, n=5). Eyes were examined by slit-lamp biomicroscopy every two days, and the animals sacrificed 21 days post-immunisation. Aqueous humour and serum interleukin-6 (IL-6) levels were determined using the B(9) bioassay, and serial tissue sections of the globes were stained with a variety of monoclonal antibodies. In the FCA group, arthritis was detected in two rats, but no rats from either group developed clinical uveitis. Immunohistochemical analysis revealed greater numbers of macrophages and MHC class II+ve cells in the irises and ciliary bodies of FCA treated rats than were seen in the FIA group. No other cellular infiltrate was detected. Serum IL-6 levels were greater in the FCA group (range 6-122 U/ml, median 42) than the FIA group (range 2-27, median 3) (p=0.018), the highest values seen in the two rats which developed arthritis (100, 122 U/ml). In the aqueous of both groups, IL-6 levels were <5 U/ml, and albumin levels were not significantly different (FCA median=2.0 mg/ml, FIA median=1.8). The authors″ results suggest that in the adjuvant induced arthritis model, infiltration with macrophages and MHC class II+ve cells occurs in the absence of clinical uveitis.

Ocular manifestations of classical and limited Wegener's granulomatosis

Wegener's granulomatosis (WG) may be subdivided into two forms, classical and limited. The latter specifically excludes renal disease and carries a better prognosis. Both forms have sight-threatening complications, but the relative incidence of ocular manifestations in each is not well documented. Patients with limited (n = 15) and classical (n = 16) WG were ophthalmologically examined. Ocular abnormalities found included orbital and nasolacrimal disease, corneo-scleral inflammation, dry eyes and retinal vein occlusion. In four patients (two from each group), no ocular disease was detected. The limited group included four potentially sight-threatening complications, compared to eight in the classical group. Overall, there was no statistically significant difference in any of the ocular manifestations between the two groups. Although treatment with corticosteroid and immunosuppressive agents has dramatically improved the prognosis of the disease, ocular morbidity is still well recognized. A combined medical and ophthalmological approach with prompt therapeutic intervention is recommended in these patients.