Masqueraded sebaceous gland carcinoma of the lower eyelid in a young pregnant patient

The purpose of this case report is to present misdiagnosed sebaceous gland carcinoma of the lower eyelid with rapid growth in a young woman during pregnancy. Eyelid sebaceous gland carcinoma is a relatively rare tumor and a disease primarily of older patients. It occurs more commonly in oriental populations and with a predilection for the upper eyelid. Early diagnosis and appropriate treatment may help improve disease control and patient survival.

Solitary Clear Cell Renal Cell Carcinoma Metastasis to the Eyelid: A Case Report

Introduction

This study is a case of solitary clear cell renal cell carcinoma (ccRCC) eyelid metastasis in a 66-year-old man as the first sign of a primary tumor. ccRCC usually spreads to the lungs, mediastinum, bones, liver, and brain, while ocular metastases are rare.

Case Presentation

Solitary metastasis presented as a solid mass in the central third of the upper eyelid, which has been growing for 3 weeks. Treatment included tumor removal and blepharoplasty. Histopathological examination showed metastasis of clear cell renal carcinoma. A thorough examination revealed a primary tumor on the lower pole of the right kidney. A right nephrectomy was performed, and histopathology showed ccRCC. Postoperative examinations showed no signs of local or systemic disease. Sunitinib malate was administered to the patient.

Conclusion

The eyelid metastasis in this case was still solitary and had been discovered before the existence of the primary tumor was known. Ocular metastasis of renal carcinoma is a rare initial manifestation of the disease and therefore requires a multidisciplinary approach in the treatment of these patients.

Cataract surgical training in Europe: European Board of Ophthalmology survey

PURPOSE

To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities.

SETTING

Countries affiliated to the European Board of Ophthalmology (EBO).

DESIGN

Cross-sectional study of anonymous survey results.

METHODS

A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022.

RESULTS

821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10.

CONCLUSIONS

CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.

The Role of Thermal Camera in the Assessment of Thyroid Eye Disease Activity

Background

Thyroid eye disease (TED; also known as thyroid - associated orbitopathy, Graves ophthalmopathy) is an autoimmune inflammatory disease which presents in typical signs and symptoms such as deep orbital pain, chemosis with or without caruncular edema, unilateral or bilateral proptosis, eyelid retraction, eyelid edema or erythema, restrictive strabismus and compressive optic neuropathy.

Objective

The aim of this study was to investigate the role of thermal camera in the assessment of thyroid eye disease (TED) activity compared to the Clinical Activity Score (CAS) scale, exophthalmometry values, and thyroid hormone and antibody levels.

Methods

A total of 50 patients participated in this cross-sectional study of whom 29 were in the active phase of TED according to the sum on CAS scale and 21 patients in the inactive phase. The Flir E8® thermal camera was used to measure the temperature of the orbital area and the values were compared with the CAS scale, exophthalmometry values and thyroid hormone and antibody levels.

Results

Higher values of temperature (p>0.0001), CAS score (p>0.0001), exophthalmometry (p=0.022), FT4 (p=0.0176) and TRAb (p=0.0091) were found in patients in the active phase of TED. Temperature of orbital area showed statistically significant positive correlation with CAS scale (p=0.0001), exophthalmometry values (p=0.0022) and anti-TPO levels (p=0.019).

Conclusion

Thermal camera showed higher values of the temperature of the orbital area in patients in the active phase of the disease and positively correlated with the CAS scale, exophthalmometry findings and anti-TPO levels.

Perforating corneal injury in rat and pentadecapeptide BPC 157

Based on its healing effects in various tissues, we hypothesized that the stable gastric pentadecapeptide BPC 157 heals corneal ulcerations in rats and effects corneal transparency. We made a penetrant linear 2-mm incision in the paralimbal region of the left cornea at the 5 o'clock position with a 20-gauge MVR incision knife at 45° under an operating microscope. Medication was BPC 157 (2 pg/mL, 2 ng/mL, and 2 μg/mL distilled water, two eye drops/left rat eye) immediately after injury induction and then every 8 h up to 120 h; controls received an equal volume of distilled water. In contrast to the poor healing response in controls, BPC 157 significantly accelerated the healing process in 2 μg and 2 ng BPC 157-treated eyes, starting 24 h after the injury, and the fluorescein and Seidel tests became negative. The epithelial defects were completely healed at 72 h (2 μg BPC 157-treated group) and at 96 h (2 ng BPC 157-treated group) after injury. Aqueous cells were absent at 96 h and 120 h after injury in the 2 μg and 2 ng BPC 157-treated groups, respectively. In conclusion, BPC 157 effects the rapid regaining of corneal transparency. Whereas controls developed new vessels that grew from the limbus to the penetrated area, BPC 157-treated rats generally had no new vessels, and those that did form in the limbus did not make contact with the penetrated area. Thus, BPC 157 eye drops successfully close perforating corneal incisions in rats.

Endogenous steroid sex hormones and atherosclerosis of retinal arteries in men

BACKGROUND

Increasing evidence suggests that both male and female sex hormones may be associated with the development of atherosclerosis, but almost all such data are based on studies of patients with coronary artery disease. To our knowledge, there are no data on the effects of endogenous sex hormones on atherosclerosis of the retinal arteries in men, and the purpose of this study was to explore that association.

MATERIAL/METHODS

In 101 consecutive adult male patients treated in a university hospital outpatient clinic, atherosclerotic changes of the retinal vessels were identified prospectively by direct ophthalmoscopy and were graded on a scale of 1 to 4 according to Scheie. Commercial radioimmunoassay kits were used to measure serum levels of testosterone, estradiol, progesterone, androstenedione, and dehydroepiandrosterone sulfate. The chi-square test was used to compare the results with those from 47 matched male subjects with healthy retinal vessels.

RESULTS

Retinal vessel atherosclerosis was inversely correlated with the serum progesterone concentration (P<0.001). The lower the progesterone concentration, the more advanced the stage of retinal vessel disease. A similar but less statistically significant correlation was noticed for dehydroepiandrosterone sulfate (P<0.05). A weak (P<0.05) similar association between the degree of retinal artery atherosclerosis and estradiol levels was also found.

CONCLUSIONS

Low endogenous progesterone levels and, to a degree, low dehydroepiandrosterone sulfate and estradiol levels might be associated with atherosclerosis of the retinal arteries in men.

[Distichiasis]

Distichiasis is a rare congenital or acquired eyelid anomaly in which an accessory row of eyelashes arises from the openings of meibomian glands or near them. The abnormal cilia are posterior to the normal row of cilia and may abrade the eye causing ocular irritation and corneal damage. We describe a 9-year-old Caucasian girl with bilateral and symmetric distichiasis. This condition was treated with lid splitting followed by cryotherapy to the posterior lid lamella. The technique has been used in four eyelids with congenital distichiasis, with very good results.

Limbal graft and/or amniotic membrane transplantation in the treatment of ocular burns

Limbal stem cell transplantation (LSCT) and amniotic membrane transplantation may improve corneal recovery after a chemical burn. Amniotic membrane was applied as a patch in 5 eyes; LSCT from healthy contralateral eye was performed in 6 eyes, and a combination of these techniques was performed in 4 eyes. There were no complications during surgical procedure. Epithelization was completed after 2 weeks in patients with LSCT, and after 3 weeks in the amniotic membrane transplantation group. Visual acuity improved in all patients. No complication was observed on either the donor or the recipient eye during a follow-up period of >13 months in all groups. Amniotic membrane is effective in promoting re-epithelization and reducing inflammation when applied alone in patients with 3- to 6-hour limbal involvement, as well as combined with LSCT in patients with >6-hour limbal ischemia. LSCT is an effective procedure for rehabilitation after severe chemical trauma of the eye with more than 50% limbal involvement.