Interesting RCT from Singapore (2013) showing that in 8 years after trabeculectomy 5-FU was no better than placebo in terms of final success rate. Which was by the way 40-55%. A food for thought. 5-FU is cheaper as MMC and is more rapidly available in some places of the world.
Authors from the US published in 2015 the results of interventional prospective comparative study, showing the benefit of oral steroids in children with orbital cellulitis, whose CRP was lower than 4 mg/ml. Those kids recovered faster! Important findings, as the condition is common in developing countries and dangerous.
Ophthalmic Plast Reconstr Surg
. Sep-Oct 2015;31(5):364-8.
Purpose: To determine both the benefit of systemic steroids in pediatric patients with orbital cellulitis and to assess the usefulness of C-reactive protein (CRP) levels as a marker for starting steroids.
Methods: Prospective, comparative interventional study. Pediatric patients aged 1 to 18 years admitted to a tertiary care children’s hospital with a diagnosis of orbital cellulitis from October 2012 to March 2014 were included in the study. All patients were treated with intravenous antibiotics, and patients with subperiosteal abscess who met previously published criteria for surgical decompression underwent combined transorbital drainage and/or endoscopic sinus surgery. CRP was measured daily as a biomarker of inflammation, and when below 4 mg/dl, patients were started on oral prednisone 1 mg/kg per day for 7 days. Patients whose families did not consent to steroid treatment served as the control group. Patients were followed after discharge until symptoms resolved and all medications were discontinued.
Results: Thirty-one children were diagnosed with orbital cellulitis during the study period. Of these 31 children, 24 received oral steroids (77%) and 7 did not (23%). There were 19 males and 5 females in the steroid group with an average age of 8.1 years, and 6 males and 1 female in the nonsteroid group with an average age of 7.1 years (p = 0.618). Thirteen patients (54%) in the steroid group and 2 patients (29%) in the nonsteroid group underwent sinus surgery with or without orbitotomy (p = 0.394). The average CRP at the onset of steroid treatment was 2.8 mg/dl (range: 0.5-4). Patients who received oral steroids were admitted for an average of 3.96 days. In comparison, patients who did not receive steroids were admitted for an average of 7.17 days (p < 0.05). Once CRP was ≤4 mg/dl, patients treated with steroids remained in the hospital for another 1.1 days, while patients who did not receive steroids remained hospitalized for another 4.9 days (p < 0.01). In the steroid group, 2 families reported increased hyperactivity in their children while on steroids. There was 1 case in each group of recurrence of symptoms after discharge from the hospital. Average follow-up time was 2.4 months in the steroid group and 2 months in the nonsteroid group (p = 0.996). At last visit, all patients returned to their baseline ophthalmic examination. There were no cases of vision loss or permanent ocular disability in either group.
Conclusions: Our results give further evidence of the safety and benefit of systemic steroids in children with orbital cellulitis. Futhermore, this is the first study to suggest a standardized starting point (CRP ≤ 4 mg/dl) and dosing schedule (oral prednisone 1 mg/kg for 7 days) for children with orbital cellulitis. Patients who received systemic steroids after CRP dropped below 4 mg/dl were discharged from the hospital earlier than patients who did not receive systemic steroids.
Authors from the Western Africa have concluded that CT-Scan plays an important role by retinoblastoma cases in developing countries, despite its well-known carcinogenic ability by this cohorta of patients. Lack of MRI in the most remote areas justifies the use of CT, according to authors. Thus they were able to reveal trilateral retinoblastoma cases and extraocular extension corresponding good with histhopathological evaluation of specimens.
J Fr Ophtalmol. 2019 Dec;42(10):1085-1089. doi: 10.1016/j.jfo.2019.06.003. Epub 2019 Sep 24.
[Role of CT in Diagnosis and Monitoring of Retinoblastoma in Senegal]
A S Sow 1 , J M M Ndiaye 2 , A M Ka 3 , D G T Sacramento 2 , H Kane 2 , M Nguer 2 , J P Diagne 3 , A M Wane 2 , E A Ba 2 , P A Ndoye Roth 2 , P A Ndiaye 3
Introduction: Retinoblastoma is a malignant tumor of neuroepithelial origin, developed from young retinal cells, occurring in infants and young children. The goal of the study was to assess the role of CT in the diagnosis of retinoblastoma at the Aristide le Dantec Hospital in Dakar.
Patients and methods: This is an 11-year retrospective study of 160 patient records in the ophthalmology department and pediatric oncology unit of the same hospital.
Results: One hundred and sixty (160) patients were recruited. The male:female ratio was 1.05. The mean age was 32.19 months. Leukocoria was the most common clinical sign, occurring in 105 cases (65.62 %). The retinoblastoma was intraocular in 97 cases (60.62 %). We saw 122 (76.25 %) unilateral and 3 (1.87 %) trilateral presentations. CT was performed in 150 children with 110 cases (73.33 %) of calcifications ; 62 cases (41.33 %) of optic nerve invasion ; 24 cases (16 %) of extraocular muscle invasion and 18 cases (12 %) endocranial extension. Associated tumors were found on CT: 2 cases of suprasellar mass and 1 case of pineoblastoma. In patients whose specimens were analyzed, histology showed 48.15 % optic nerve invasion, consistent with the CT findings.
Discussion: CT has an important role in the diagnosis of retinoblastoma, despite its recent contraindication in bilateral and unilateral multinodular forms.
Conclusion: CT is a good alternative to MRI in the diagnosis of retinoblastoma in developing countries with limited technological resources.
Steffen J1, Coupland SE2,3, Smith JR4.
1. Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
2. Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
3. Liverpool Clinical Laboratories, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
4. Eye and Vision Health, Flinders University, Adelaide, Australia.
Purpose: To describe the epidemiology, clinical characteristics, diagnosis and treatment of human immunodeficiency virus (HIV)-related primary vitreoretinal lymphoma (PVRL).Methods: Narrative literature review.Results: HIV-related PVRL occurs in persons who are relatively young and generally have very low CD4+ T-cell counts. Vitritis with subretinal or sub-retinal pigment epithelial infiltrates is typical. Vitreous cytology remains the gold standard for diagnosis, supplemented by flow cytometry and genetic analyses of tumor cells, and measurement of aqueous or vitreous interleukin-10 levels. Concurrent brain involvement also may establish the diagnosis. Treatment includes antiretroviral therapy (ART), systemic chemotherapy (usually methotrexate-based) and local ocular treatment (intravitreal methotrexate, intravitreal rituximab, external beam radiotherapy). Systemic chemotherapy is of uncertain value for PVRL without other central nervous system involvement. Prognosis is poor, but has improved significantly compared to the pre-ART era. Conclusions: Ophthalmologists should consider the diagnosis of PVRL in HIV-positive individuals who present with intermediate or posterior uveitis.