Mechanisms of secondary glaucoma in eyes with advanced retinoblastoma: histopathological

Purpose: The association between retinoblastoma (RTB) and secondary glaucoma is well known. The most common cause of secondary glaucoma in RTB is iris neovascularization, followed by pupillary block and tumor seeding in the anterior chamber. Aim of this study is to review the glaucoma-inducing mechanism in a large italian population of RTB patients and discuss our experience with these cases Methods: . In the last five years we observed 152 cases of RTB; in 18 cases (17%) during the first examination under general anesthesia, elevated intraocular pressure was observed. Histopathological examination of these eyes was performed to understand the mechanisms inducing glaucoma. Results: In six patients only (33%) the mechanism seemed to be an isolated one (four tumor seeding and two angle closure), in 12 patients (66%) a combination of more than one mechanism was observed (angle closure, tumor seeding and iris neovascularization Conclusions: Although glaucoma is a secondary clinical issue in RTB management and care of its presence, revealed by a thorough ocular exam of the anterior segment, can guide the clinician in assessing the overall condition of the affected ey

Use of hypo-osmolar ribofl avin for corneal cross-linking in thinkeratoconic corneas

Purpose To evaluate the effi cacy of UVA collagen cross linking (CXL) on thin keratoconic corneas with previous application of hypoosmolar ribofl avin solution. Methods Twelve eyes of 12 patients with progressive keratoconus and a corneal thickness of less than 400 μm without the epithelium, were submitted to collagen crosslinking after the application of an hypoosmolar ribofl avin solution. We instilled one drop every 5 seconds for 2 or 4 minutes to increase corneal thickness up to a minimum value of 400 μm. Pachimetry measurements were taken every 30 seconds to verify the eff ect on corneal stroma. Results Mean corneal thickness improved in most cases with reduction of the mean K-value of the keratoconus and no progressionwas observed at six and twelve months after CXL. One year after treatment no scarring lesions in the stroma were observed and all corneas were transparent. Improvement of visual acuity was signifi cant in three patients (25%), low but detectable in seven patients (51%) and no modifi cations of visual acuity were observed in two patients (24%). Conclusion Hypoosmolar ribofl avin solution showed to be useful to allow CXL procedure in keratoconic corneas with low stromalthickness. No progression of keratoconus was observed six months and one year afer CXL., no developing of stromal scars and patients showed good stability of visual acuity delaying time of surgery

Possibilities and limitations of imaging techniques in the infiltrative orbital lesions. [POSSIBILITA E LIMITI DELLA SEMEIOLOGIA D'IMMAGINE NELLA PATOLOGIA INFILTRATIVA DELL'ORBITA]

The A uthors repo rt some cases (3 basai celi carcinoma, l l acr imai gian d adenocar cin oma , l h ema ngioperi cyto­ ma) wh ere imagin g techniques (CT-scan) could not clarify clinica! suspi cions or wh e r e intra-opera tive findings were in con trast with images. Pa rti c ularl y difficult was t h e differentiation betw een neoplastic a nd cicatri cial (especiall y aft e r radiotherapy) tiss u e

Giant orbital retinoblastoma: a case report

Purpose The authors report a case of giant orbital Retinoblastoma following primary enucleation for intraocular tumor. The presence of worms was documented inside the necrotic tumoral mass. Methods The child was diagnosed with unilateral advanced retinoblastoma at the age of one month and enucleated. Chemotherapy and/or radiotherapy had no been performed. 3 months later a mass started growing in the anophthalmic socket and when the child arrived to our referral center the mass was as big as the child’s head. Complete excision of the mass and exenteration have been performed and the presence of worms has been documented in the necrotic part of tumor. Diagnostic workup included computed tomography (CT) and magnetic resonance (MR) of the head and orbit, bone scintigraphy, lumbar puncture with cell count and examination of the cytocentrifugate and bone marrow aspiration. Results The child died 6 months after. Conclusion We describe an extraordinary case of a giant orbital Retinoblastoma following enucleation

Rottura diaframmatrica con erniazione intratoracica del fegato. Presentazione di due casi clinici

Gli Autori presentano due casi di rottura diaframmatica da trauma chiuso toraco-addominale, con erniazione intratoracica del fegato, conseguenti ad incidente della strada. La diagnosi preoperatoria è stata posta mediante esecuzione di esame TC. Al momento dell’intervento si è optato per l’accesso laparotomico, mediano per un paziente e bisottocostale per l’altro, che ha permesso la riparazione diretta della lesione diaframmatica e una adeguata gestione delle lesioni associate, presenti in entrambi i casi. Non si è fatto uso di materiale protesico e la ricostruzione del diaframma è avvenuta in sutura a punti staccati in materiale non riassorbibile. Nella nostra esperienza la riparazione della lesione diaframmatica è sempre stata possibile attraverso un approccio laparotomico e senza l’ utilizzo di materiale protesico. Riteniamo che, in questi casi, l’approccio migliore sia proprio quello laparotomico che permette non solo la riparazione della lesione diaframmatica, ma anche la gestione delle lesioni associate. Utilizziamo in genere una sutura a punti staccati in materiale non riassorbibile per lacerazioni di minor entità e una continua, se possibile in doppio strato, per quelle più grandi

Alternated intra-arterial and intravitreal chemotherapy for advanced intraocular retinoblastoma: preliminary successful results without systemic chemotherapy

To describe the efficacy of intravitreal chemotherapy (IViC) preceded by intra-arterial chemotherapy (IAC) for the treatment of advanced stage retinoblastoma. This non-comparative interventional case series retrospectively reviewed the medical records of six patients who presented within months of each other with unilateral retinoblastoma, Reese–Ellsworth stage Vb/D of ABC classification in the affected eye. After clinical and ophthalmoscopic evaluation, they underwent MRI to exclude local and CNS dissemination. The IAC was given to treat retinal masses and intravitreal injections to treat vitreous seeding. Patients had received two cycles (six infusions) of IAC, and from six up to ten melphalan injections into the vitreous, with an interval of 7–10 days between them. From one to four intravitreal injections were performed for partial remission or consolidation. No permanent complications of procedures have been reported. All patients underwent to bimonthly MRI examination, during treatment and every 3 months for 1 year after last injection, to exclude orbital dissemination. Successful control (100 %) of tumor masses and vitreous seeds was achieved in all cases at 12 months follow-up. Complications were posterior lens opacity, acute ischemic papillitis, partial CVR thrombosis, hypotonia (case 1), partial vitreous hemorrhage (case 4). No complications appeared in cases 2, 3, 5, and 6. No intraocular or orbital tumor recurrence or retinoblastoma metastases (follow-up range, 12–33 months) were observed. Sequential IAC and intravitreal melphalan for advanced retinoblastoma allowed to provide retinal and vitreous seed control

Supero-lateral orbitotomy for resection of spheno-orbital meningioma: a case report

Spheno-orbital meningioma have traditionally been defined as secondary tumors of the orbit originating from the dura of the sphenoid wing bone. Nevertheless, pathologic findings reveal a distinct periorbital component as a defining feature of these lesions. These tumors are characterized by an intraosseous mass growth leading to a significant hyperostosis involving the sphenoid wing, the orbital roof, the lateral orbital wall and the middle fossa cranial base and to a thin, usually soft-tissue growth at the dura. We report here on the extension of the primary tumor into the orbital cavity and present the surgical approach performed

Pterygomaxillary extension of orbital pseudotumor. Case report

Lo pseudotumore orbitario è un’ infiammazione benigna, aspecifica e idiomatica, localizzata nell'orbita e con eccezionale estensione alla base cranica. La sua eziopatogenesi non è conosciuta, definirne la natura istologica è importante per un corretto trattamento. Riportiamo un raro caso di pseudotumor orbitario con estensione nella fossa infratemporale discutendone gli aspetti clinici e terapeutici