Medical Library

Chloroquine-related myasthenic syndrome with severe retinopathy.

Ritenour RJ, Cruess AF, Mishra AV.

Vision health: seeing how medical students can contribute.

Morogan A.

Eyelid primary diffuse large B-cell lymphoma.

Huerva V, Canto LM.

Paracentesis before intravitreal injection of bevacizumab.

Tsui YP, Chiang CC, Tsai YY.

Paracentesis before intravitreal injection of bevacizumab-Author reply.

Hollands H, Campbell RJ, Sharma S, Gale J.

Transconjunctival orbitotomy for orbital cavernous hemangiomas.

Background: Orbital cavernous hemangiomas, particularly those within the retrobulbar space, are approached by neurosurgeons as well as by ophthalmic surgeons. Several surgical techniques have been applied over the past decades. Less traumatic approaches in this functionally and cosmetically important region are desirable. We describe a transconjunctival approach in 39 patients with orbital cavernous hemangiomas.Methods: Thirty-nine patients with orbital cavernous hemangiomas were treated with transconjunctival orbitotomy. The clinical and radiologic characteristics of orbital cavernous hemangiomas were analyzed in the course of their appropriate treatment.Results: In all patients, cavernous hemangiomas were just behind the globe or were compressing it. Computed tomography and magnetic resonance imaging showed orbital cavernous hemangiomas as round, well-defined intraconal masses. In 37 cases, the tumors were removed intact, and only 1 patient suffered permanent vision loss as a result of intraoperative hemorrhage. In the other 2 cases, the tumor fragments were incompletely removed. Visual acuity increased in 6 of the 9 cases with primary visual impairment. Thirty-two patients with primary proptosis were resolved completely. Six patients with visual field defect were also improved.Interpretation: Retrobulbar intraconal cavernous hemangiomas can be removed successfully through a transconjunctival approach. However, if the tumor is close to, or touching, the orbital apex, adhering tightly to retrobulbar tissue, or combined with large draining veins, operation through other approaches must be considered.

Cheng JW, Wei RL, Cai JP, Li Y.

Ring melanoma of the ciliary body: clinical and ultrasound biomicroscopic characteristics.

Background: Diagnosis of ring melanoma is clinically difficult since the mass can remain hidden with standard slit-lamp biomicroscopy. The aim of this study was to evaluate the utility of ultrasound biomicroscopy (UBM) as a diagnostic tool for ring melanoma of the ciliary body.Methods: This was a retrospective study of 6 eyes of 6 patients at Princess Margaret Hospital, Toronto, Ont., with a diagnosis of ring melanoma of the ciliary body. The tumor extension was measured clinically, gonioscopically, ultrasonographically (by UBM), and pathologically.Results: Since 2000, 6 cases of ring melanoma have been diagnosed at Princess Margaret Hospital: 2 women and 4 men, median age 57 years. Five patients presented as uncontrolled hyperchromic glaucoma (83%). Ciliary body involvement on slit-lamp examination ranged from 60 masculine to 180 masculine. Ciliary body involvement as assessed by UBM ranged from 180 masculine to 300 masculine. Tumor extension according to pathological examination ranged from 210 masculine to 360 masculine. With these measures, the ring melanoma clinical criteria were not filled by 5 patients.Interpretation: UBM is an important tool in determining the extent of ciliary body involvement and classifying these lesions.

Vásquez LM, Pavlin CJ, McGowan H, Simpson ER.

Bleb needle redirection for the treatment of early postoperative trabeculectomy leaks: a novel approach.

Background: This study describes a technique of bleb needling as a management of early postoperative limbal bleb leaks unresponsive to conservative management. This technique redirects the aqueous into a newly formed bleb, sealing the leak easily and rapidly.Methods: Medical records of patients with early bleb leaks after trabeculectomy or phacotrabeculectomy between November 2004 and September 2005 were reviewed retrospectively. Patients whose bleb leaks were unresponsive to conservative management and who underwent needling procedures were identified and studied further.Results: Six of 18 patients who had early bleb leaks did not respond to conservative treatment and underwent a needle redirection of their blebs, which sealed within a few days after needling. The mean follow-up time of this group was 6 months. The mean preoperative vision was 20/50 with a mean preoperative intraocular pressure (IOP) of 27 using 2.8 medications, and this improved postoperatively and postneedling to a vision of 20/30 with a mean IOP of 11 using 0.16 medications.Interpretation: Bleb needling with subsequent redirection of aqueous into a new bleb should be considered as an option in the treatment of limbal leaks after a trabeculectomy that does not respond to conservative treatment.

Ares C, Kasner OP.

Finger massage versus a novel massage device after trabeculectomy.

Background: Ocular massage is a common technique employed after trabeculectomy to aid filtration. This pilot study compares a novel ocular massage device (MD) with finger massage (FM) after trabeculectomy. The device provides the patient with audio feedback about correctly applied force, and the force applied can be customized for each patient.Methods: A prospective, randomized study was performed comparing the effects of FM versus MD on intraocular pressure (IOP) and complication rates. All patients were given a standardized tutorial in ocular massage. The efficiency of their massage technique was evaluated at 1 week by having the patient perform the massage in front of the ophthalmologist, with IOP measurements taken before and after massage. Information on bleb morphology, IOP, ocular medications, and complications were recorded on a weekly basis. The patient perspective was recorded by questionnaire at 1 week, 1 month, and 3 months after initiation of the massage.Results: Twenty-five patients were enrolled in the study, 12 randomly assigned to the FM and 13 to the MD groups. Patients in the MD group were much more confident that they were doing the massage correctly (p = 0.009) and reported a greater ease of use and lower pain scores. The mean difference in IOP in the 2 groups was not statistically significant in the first 3 weeks, and IOP after 3 months was statistically similar in both groups. Laser suture lysis was performed in 8 patients (66%) in the FM versus 6 (46%) in the MD group (p = 0.42). Wound leaks developed in 4 patients (3 in the FM group vs. 1 in the MD group, p = 0.32).Interpretation: The massage device shows promise as an adjunctive tool in the postoperative management of trabeculectomies.

Gouws P, Buys YM, Rachmiel R, Trope GE, Fresco BB.

Medical students\’ attitudes on diversity when applying to Toronto\’s ophthalmology residency program.

Background: Affirmative action is a controversial admissions policy practised by universities in the United States and other countries around the world. It is currently not used at the University of Toronto ophthalmology residency program. A survey was conducted to determine the opinions of applicants as to the role that affirmative action and quotas should play during the admissions process and to determine the current ethnic breakdown of the applicants to ophthalmology.Methods: A survey of 14 questions was sent out to all 72 medical students applying for a residency position in our program. The response rate was 58%. The students were asked to agree or disagree on a 5-point Likert scale with statements related to ethnicity, gender, and whether affirmative action policies exist or should exist for certain groups.Results: The majority of the respondents (26/42, 62%) considered themselves an ethnic minority, and 57% (24/42) considered themselves a visible minority. Most (32/42) felt that the sex of the applicant should not play a role in the selection process. Only 24% (10/42) supported affirmative action, and only 12% (5/42) supported quotas for minority applicants.Interpretation: The majority of survey respondents in this study did not support affirmative action or quotas at the University of Toronto ophthalmology program. The applicants to this program represent a diverse group of individuals from a multitude of ethnic, cultural, and racial backgrounds, and, in their average opinion, affirmative action policies would not benefit our admissions program.

Christakis TJ, Christakis PG, Chipman ML, Christakis JT.