Efficacy of endoscopic sinus surgery for paranasal sinus mucocele including modified endoscopic Lothrop procedure for frontal sinus mucocele

This study evaluated the efficacy of the modified endoscopic Lothrop procedure (MELP) for complicated frontal mucoceles and endoscopic marsupialization for other paranasal sinus mucoceles. It was a retrospective, consecutive case review of sinus mucoceles treated endoscopically by a single surgeon over a four-year period (1998-2002). There were 41 mucoceles in 28 patients, including 24 frontal, eight frontoethmoidal, three ethmoidal, five maxillary and one frontal mucocele. Twenty-one patients underwent the modified Lothrop procedure for frontal mucoceles, and seven underwent simple drainage and marsupialization for frontoethmoidal, ethmoidal and maxillary mucoceles. At median follow-up of 16 months, all patients had a patent mucocele opening. Patients treated by drainage and marsupialization did not have any complications or mucocele recurrence. All patients treated by the modified endoscopic Lothrop procedure had improvement in symptoms and signs. Four patients had minor complications including epistaxis and adhesions and five required further surgery. The average hospital in-patient stay was 2 ± 1.4 days. Endoscopic techniques, including MELP are effective in the short term for the management of complex and simple paranasal sinus mucoceles. MELP has a useful place in the management of mucoceles with a significant bony partition from an adjacent sinus or nasal cavity. It is also indicated when the mucocele is associated with loss of lateral support in the sinus with risk of medial-wall collapse of the orbital contents obstructing drainage.Jwu Jin Khong, Raman Malhotra, Dinesh Selva and Peter John Wormal

Lesions mimicking lacrimal gland pleomorphic adenoma

Aim: To report a series of patients with lacrimal gland lesions simulating the clinicoradiological features of lacrimal gland pleomorphic adenoma (LGPA). Methods: Multicentre retrospective, interventional case series. Clinical records of all patients with lesions mimicking LGPA seen in five orbital units were reviewed. Results: The study included 14 patients (seven men and seven women) with a mean age of 50.9 years. The diagnosis of LGPA was made in all cases by experienced orbital surgeons, based on clinicoradiological features, and lacrimal gland excision was performed. Postoperative histology revealed lymphoma (four patients), chronic dacryoadenitis (three patients), adenoid cystic carcinoma (two patients), Sjogren's syndrome (two patients), cavernous haemangioma (one patient), benign lymphoid hyperplasia (one patient) and granulomatous dacryoadenitis (one patient). Comparison with the total number of histologically confirmed LGPA cases seen during the study period revealed that 22.6% of cases of suspected LGPA were misdiagnosed based on clinicoradiological criteria. Conclusions: Many different lesions may mimic the clinicoradiological features of LGPA. The accepted clinicoradiological criteria used for the diagnosis of LGPA have a high false-positive rate, even in experienced hands. Based on this study, the authors believe that fine-needle aspiration biopsy or intraoperative biopsy and frozen section diagnosis may help reduce unnecessary lacrimal gland excision.Venkatesh C Prabhakaran, Paul S Cannon, Alan McNab, Garry Davis, Brett O’Donnell, Peter J Dolman, Raf Ghabrial, Dinesh Selv

Primary radiotherapy in progressive optic nerve sheath meningiomas: a long-term follow-up study

Background/aims: To report the outcome of primary radiotherapy in patients with progressive optic nerve sheath meningioma (ONSM). Methods: The clinical records of all patients were reviewed in a retrospective, observational, multicentre study. Results: Thirty-four consecutive patients were included. Twenty-six women and eight men received conventional or stereotactic fractionated radiotherapy, and were followed for a median 58 (range 51–156) months. Fourteen eyes (41%) showed improved visual acuity of at least two lines on the Snellen chart. In 17 (50%) eyes, the vision stabilised, while deterioration was noted in three eyes (9%). The visual outcome was not associated with age at the time of radiotherapy (p=0.83), sex (p=0.43), visual acuity at the time of presentation (p=0.22) or type of radiotherapy (p=0.35). Optic disc swelling was associated with improved visual acuity (p<0.01) and 4/11 patients with optic atrophy also showed improvement. Long-term complications were dry eyes in five patients, cataracts in three, and mild radiation retinopathy in four. Conclusion: Primary radiotherapy for patients with ONSM is associated with long-term improvement of visual acuity and few adverse effects.Peerooz Saeed, Leo Blank, Dinesh Selva, John G. Wolbers, Peter J.C.M. Nowak, Ronald B. Geskus, Ezekiel Weis, Maarten P. Mourits, Jack Rootma

Air regurgitation in patients on continuous positive airway pressure (CPAP) therapy following dacrocystorhinostomy with or without Lester-Jones tube insertion

Aim: To describe air regurgitation as a complication in patients on continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) following dacryocystorhinostomy (DCR) surgery with or without Lester–Jones tube (LJT) insertion. Methods: A retrospective review of all patients with air regurgitation on CPAP therapy who previously underwent a DCR/LJT procedure. Patient demographics, lacrimal surgical history, CPAP therapy and outcome were recorded. Results: Four male patients were identified. The mean age at presentation was 54 years. Two patients had an LJT inserted, and two patients had a DCR procedure, one was external, and one was endonasal. All four patients had resolution of their epiphora. Three patients had superficial epithelial keratopathy requiring lubricant therapy. All patients attempted using ointment to act as a barrier over the neo-ostium, which was unsuccessful. One patient had the LJT removed with resolution of the air regurgitation. Two patients changed their CPAP machines to variable, and three patients reduced the pressure of their CPAP therapy without any improvement. All three patients had persistence of air regurgitation at a mean follow-up of 18 months. Conclusions: Air regurgitation can occur following naso-lacrimal surgery in patients on CPAP therapy. Although this is an unusual complication, it should be discussed with the patient at the time of obtaining informed consent.Paul S. Cannon, Simon N. Madge, Dinesh Selv

Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory

Objective: To investigate whether Indigenous Australians with cancer have more advanced disease at diagnosis than other Australians, and whether late diagnosis explains lower Indigenous cancer survival rates. Design: Retrospective cohort study. Setting and participants: Indigenous and non-Indigenous people diagnosed with cancers of the colon and rectum, lung, breast or cervix and non-Hodgkin lymphoma in the Northern Territory of Australia in 1991–2000. Main outcome measures: SEER summary stage of cancer at diagnosis (local, regional or distant spread), cause-specific cancer survival rates and relative risk of cancer death. Results: Diagnosis with advanced disease (regional or distant spread) was more common for Indigenous people (70%; 95% CI, 62%–78%) than for non-Indigenous people (51%; 95% CI, 53%–59%) with cancers of the colon and rectum, breast, cervix and non-Hodgkin lymphoma, but for lung cancer the opposite was found (Indigenous, 56% [95% CI, 46%–65%] v non-Indigenous, 69% [95% CI, 64%–75%]). Stage-adjusted survival rates were lower for Indigenous people for each cancer site. With few exceptions, the relative risk of cancer death was higher for Indigenous people for each category of stage at diagnosis for each cancer site. Conclusions: Health services apparently could, and should, be performing better for Indigenous people with cancer in the Northern Territory, and probably elsewhere in Australia. This study has demonstrated that data from cancer registers, enhanced with data on stage at diagnosis, can be used to monitor health service performance for Indigenous Australians in the Northern Territory; similar data is available in other States, and could be used to monitor health service performance for Indigenous people throughout Australia

Allergic contact dermatitis: a case series and review for the ophthalmologist

Eyelid dermatitis is most commonly caused by an allergenic response, potentially from exposure at another site, rather than from local toxicity. Yet allergic contact dermatitis is a diagnosis often missed by ophthalmologists. The authors review the literature and detail their experience relating to the causes, clinical features and management of this condition. 14 patients over a 2-year period that were referred to the oculoplastic service for a further opinion were reviewed in a retrospective, non-comparative study. All patients underwent patch testing for diagnosis. 8 of the 14 patients had delays of more than 6 months from symptoms to diagnosis. In six of these, this was greater than 1 year. Similar delays are reported in the literature. 79% of the cases were referred by ophthalmologists. Although two of the patients were biopsied, this did not help in making the diagnosis. 13 patients had disease restricted to the eyelids, though only five of these had direct contact of the allergen with the eyelids. Two patients were also sensitised to topical steroid creams prescribed for their treatment. All patients improved after removal of the allergen. Further clinical features and management options from the literature are reviewed and discussed.Sharon Morris, Richard Barlow, Dinesh Selva, Raman Malhotr

Punctal stenosis: definition, diagnosis, and treatment

Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition is a rare cause of symptomatic epiphora, but its incidence may be higher in patients with chronic blepharitis, in those treated with various topical medications, including antihypertensive agents, and especially in patients treated with taxanes for cancer. The purpose of this review is to cover the medical literature, focusing in particular on definition, incidence, risk factors, etiology and treatment options.Uri Soiberman, Hirohiko Kakizaki, Dinesh Selva, Igal Leibovitc

Muir-Torre syndrome and early detection of internal malignancy

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Celia S Chen, Lindy Loweinstein, Craig James, Shyamala C Huilgol and Dinesh Selv

Tissue engineering in ophthalmology: Implications for eyelid reconstruction

Bioengineering aims to produce functional tissue replacements to repair defects and has been widely investigated over the past few decades. We aimed to review the available literature on the application of tissue engineering in ophthalmology, with a particular focus on ophthalmic plastic surgery and potential applications for eyelid reconstruction.A literature search was performed on the MEDLINE database using the keywords "bioengineering," "tissue engineering," and "ophthalmology." Articles written in English were included.There is a substantial body of work on tissue engineering of the cornea. Other structures in ophthalmology investigated include the conjunctiva, lacrimal gland, and orbital bone. We also discuss the potential application of tissue engineering in eyelid reconstruction.Tissue engineering represents the future of regenerative and reconstructive medicine, with significant potential applications in ophthalmic plastic surgery.Michelle T. Sun, Andrea J. O'Connor, John Wood, Robert Casson and Dinesh Selv

Prevalence and determinants of age-related macular degeneration in central Sri Lanka: the Kandy Eye Study

Aims To determine the prevalence, associations and risk factors for age-related macular degeneration (ARMD) in central Sri Lanka. Methods The study was a population-based, cross-sectional survey of residents aged ≥40 years in rural Sri Lanka. ARMD was assessed on dilated fundoscopy using the International Age-Related Maculopathy Epidemiology Study Group classification system. Results Of the 1721 subjects identified, 1375 participated (79.9%). Of the participants, 1013 were aged ≥50 years (73.6%). The prevalence of any ARMD (adjusted for study design) was 4.72 (95% CI 2.22 to 7.20)% with 3.82 (95% CI 1.60 to 6.04)% early ARMD and 1.70 (95% CI 0.14 to 3.27)% late ARMD. Age (p<0.001) and Sinhalese ethnicity (p = 0.016) were significantly associated with ARMD. Men had a tendency toward a higher prevalence of ARMD than women, although this was not statistically significant (p = 0.081). Ocular risk factors such as cortical cataract (p = 0.024) and pseudophakia (p = 0.003) were associated with ARMD on the univariate but not multivariate analyses. Illiteracy and the identification of social supports were significantly associated with ARMD on univariate analyses. However, only social support was statistically significant after multivariate analysis (p = 0.024). Conclusions Although the prevalence of ARMD is slightly lower in Sri Lanka than surrounding regions, it contributes to a higher proportion of visual impairment, including blindness. Risk factors include age and Sinhalese ethnicity.L A Goold, K Edussuriya, S Sennanayake, T Senaratne, D Selva, T R Sullivan, R J Casso