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Nicola Pritchard - One of the best experts on this subject based on the ideXlab platform.
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confocal microscopy of the bulbar conjunctiva in contact lens wear
Cornea, 2010Co-Authors: Nathan Efron, Munira Aldossari, Nicola PritchardAbstract:Purpose: The aim of this study was to investigate the capabilities of laser scanning confocal microscopy (LSCM) for undertaking qualitative and quantitative investigations of the response of the bulbar conjunctiva to contact lens wear. Methods: LSCM was used to observe and measure morphological characteristics of the bulbar conjunctiva of 11 asymptomatic soft contact lens wearers and 11 healthy volunteer subjects (controls). Results: The appearance of the bulbar conjunctiva is consistent with known histology of this tissue based on light and electron microscopy. The thickness of the bulbar Conjunctival epithelium of lens wearers (30.9 ± 1.1 μm) was less than that of controls (32.9 ± 1.1 μm) (P < 0.0001). Superficial and basal bulbar Conjunctival epithelial cell densities in contact lens wearers were 91% and 79% higher, respectively, than that in controls (P < 0.0001). No difference was observed in goblet and Langerhans cell density between lens wearers and controls. Conjunctival microcysts were observed in greater numbers, and were larger in size, in lens wearers compared with controls. Conclusions: The effects of contact lens wear on the human bulbar conjunctiva can be investigated effectively at a cellular level using LSCM. The observations in this study suggest that contact lens wear can induce changes in the bulbar conjunctiva such as epithelial thinning and accelerated formation and enlargement of microcysts, increased epithelial cell density, but has no impact on goblet or Langerhans cell density.
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In vivo confocal microscopy of the bulbar conjunctiva
Clinical and Experimental Ophthalmology, 2009Co-Authors: Nathan Efron, Munira Al-dossari, Nicola PritchardAbstract:Background: The aim of this work is to develop a more complete qualitative and quantitative understanding of the in vivo histology of the human bulbar conjunctiva. Methods: Laser scanning confocal microscopy (LSCM) was used to observe and measure morphological characteristics of the bulbar conjunctiva of 11 healthy human volunteer subjects. Results: The superficial epithelial layer of the bulbar conjunctiva is seen as a mass of small cell nuclei. Cell borders are sometimes visible. The light grey borders of basal epithelial cells are clearly visible, but nuclei can not be seen. The Conjunctival stroma is comprised of a dense meshwork of white fibres, through which traverse blood vessels containing cellular elements. Orifices at the epithelial surface may represent goblet cells that have opened and expelled their contents. Goblet cells are also observed in the deeper epithelial layers, as well as Conjunctival microcysts and mature forms of Langerhans cells. The bulbar conjunctiva has a mean thickness of 32.9 ± 1.1 µm, and a superficial and basal epithelial cell density of 2212 ± 782 and 2368 ± 741 cells/mm2, respectively. Overall goblet and mature Langerhans cell densities are 111 ± 58 and 23 ± 25 cells/mm2, respectively. Conclusions: LSCM is a powerful technique for studying the human bulbar conjunctiva in vivo and quantifying key aspects of cell morphology. The observations presented here may serve as a useful marker against which changes in Conjunctival morphology due to disease, surgery, drug therapy or contact lens wear can be assessed.
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In Vivo Confocal Microscopy of the Bubar Conjunctiva
Clinical and Experimental Ophthalmology, 2009Co-Authors: Nathan Efron, Munira Al-dossari, Nicola PritchardAbstract:Background: The aim of this work is to develop a more complete qualitative and quantitative understanding of the in vivo histology of the human bulbar conjunctiva. Methods: Laser scanning confocal microscopy (LSCM) was used to observe and measure morphological characteristics of the bulbar conjunctiva of 11 healthy human volunteer subjects. Results: The superficial epithelial layer of the bulbar conjunctiva is seen as a mass of small cell nuclei. Cell borders are sometimes visible. The light grey borders of basal epithelial cells are clearly visible, but nuclei can not be seen. The Conjunctival stroma is comprised of a dense meshwork of white fibres, through which traverse blood vessels containing cellular elements. Orifices at the epithelial surface may represent goblet cells that have opened and expelled their contents. Goblet cells are also observed in the deeper epithelial layers, as well as Conjunctival microcysts and mature forms of Langerhans cells. The bulbar conjunctiva has a mean thickness of 32.9 1.1 mm, and a superficial and basal epithelial cell density of 2212 782 and 2368 741 cells/ mm2, respectively. Overall goblet and mature Langerhans cell densities are 111 58 and 23 25 cells/mm2, respectively. Conclusions: LSCM is a powerful technique for studying the human bulbar conjunctiva in vivo and quantifying key aspects of cell morphology. The observations presented here may serve as a useful marker against which changes in Conjunctival morphology due to disease, surgery, drug therapy or contact lens wear can be assessed.
Jerry A Shields - One of the best experts on this subject based on the ideXlab platform.
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eyelid Conjunctival and orbital tumors an atlas and textbook
2015Co-Authors: Carol Shields, Jerry A ShieldsAbstract:TUMORS OF THE EYELIDS Benign Tumors of the Eyelid Epidermis Premalignant and Malignant Tumors of Eyelid Epidermis Eyelid Sebaceous Gland Tumors Eyelid Sweat Gland Tumors Eyelid Hair Follicle Tumors Eyelid Melanocytic Tumors Neural Tumors of the Eyelid Vascular Tumors of the Eyelids Eyelid Lymphoid, Plasmacytic, and Metastatic Tumors Eyelid Histiocytic, Myxoid, and Fibrous Lesions Eyelid Cystic Lesions Simulating Neoplasms Eyelid Inflammatory Lesions Simulating Neoplasms Eyelid Miscellaneous Conditions Simulating Neoplasms Tumors of the Lacrimal Drainage System Surgical Management of Eyelid Tumors TUMORS OF THE CONJUNCTIVA Conjunctival and Epibulbar Choristomas Conjunctival Benign Epithelial Tumors Premalignant and Malignant Tumors of the Conjunctival Epithelium Conjunctival Melanocytic Tumors Vascular Tumors Related Lesions of the Conjunctiva Conjunctival Neural, Xanthomatous, Fibrous, Myxomatous, and Lipomatous Tumors Conjunctival Lymphoid, Leukemic, and Metastatic Tumors Caruncular Tumors Miscellaneous Lesions That Simulate Conjunctival Neoplasms Surgical Management of Conjunctival Tumors TUMORS OF THE ORBIT Inflammatory Lesions That Simulate Neoplasms Orbital Cystic Lesions Orbital Vascular and Hemorrhagic Lesions Orbital Peripheral Nerve Tumors Optic Nerve, Meningeal, and Other Neural Tumors Orbital Myogenic Tumors Orbital Fibrous Connective Tissue Tumors Orbital Osseous, Fibro-osseous, and Cartilaginous Tumors Orbital Lipomatous and Myxomatous Tumors Orbital Histiocytic Tumors and Pseudotumors Orbital Primary Melanocytic Tumors Lacrimal Gland Primary Epithelial Tumors Orbital Metastatic Cancer Orbital Lymphoid Tumors and Leukemias Orbital Secondary Tumors Surgical Management of Orbital Tumors
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Conjunctival amyloidosis report of six cases and review of the literature
Survey of Ophthalmology, 2006Co-Authors: Hakan Demirci, Carol L Shields, Ralph C Eagle, Jerry A ShieldsAbstract:Conjunctival amyloidosis is an uncommon condition that occasionally is associated with systemic involvement. The clinical presentations of Conjunctival amyloidosis are diverse. We present six patients with Conjunctival amyloidosis who were referred to us with the suspicion of another Conjunctival lesion. The Conjunctival lesion was circumscribed in two patients and diffuse in four patients. The lesion color was yellow in one patient and yellow-pink in five patients. The associated features were intrinsic vascularization (six patients), recurrent subConjunctival hemorrhage (four patients) and blepharoptosis that involved the palpebral conjunctiva (two patients). Systemic evaluation revealed primary systemic amyloidosis in one patient and no related systemic abnormalities in five patients. Management consisted of complete excisional biopsy for the two circumscribed lesions and incisional biopsy for the four diffuse lesions. Two patients with diffuse involvement showed progressive involvement of the conjunctiva over 3 years following incisional biopsy and the other four patients remained stable. Additionally, there was no systemic involvement in five patients. In conclusion, Conjunctival amyloidosis generally manifests as a yellowish-pink, hemorrhagic mass deep to the epithelium. Most patients show no evidence of systemic amyloidosis.
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Conjunctival epithelial involvement by eyelid sebaceous carcinoma the 2003 j howard stokes lecture
Ophthalmic Plastic and Reconstructive Surgery, 2005Co-Authors: Jerry A Shields, Hakan Demirci, Brian P Marr, Ralph C Eagle, Mary A Stefanyszyn, Carol L ShieldsAbstract:PURPOSE: To determine incidence and distribution of Conjunctival epithelial involvement by eyelid sebaceous carcinoma and to make recommendations regarding its management. METHODS: The medical records were reviewed retrospectively on patients with histopathologically confirmed sebaceous carcinoma of the eyelids managed at the Oncology Service at Wills Eye Hospital. Those tumors with involvement of the Conjunctival epithelium were identified and selected for further study. The incidence and distribution of epithelial involvement was determined, based on histopathology of resected tumors and map biopsies. The incidence of metastasis and tumor-related mortality was determined. Based on these findings and personal surgical experience, recommendations are made regarding management of eyelid sebaceous carcinoma with involvement of the Conjunctival epithelium. RESULTS: Of 60 patients with sebaceous carcinoma, epithelial involvement of the conjunctiva was identified in 28 (47%). Of the 28 cases, the neoplasm affected the following sites: superior tarsal and fornical conjunctiva in 28 (100%), inferior tarsal conjunctiva in 19 (68%), inferior fornical conjunctiva in 18 (64%), superior bulbar conjunctiva in 19 (68%), and inferior bulbar conjunctiva in 16 (57%). The caruncle was involved in 15 (54%) and the cornea in 11 (39%). Metastasis occurred in 3 of the 28 cases (11%). Map biopsies, combined with cryotherapy, topical chemotherapy, local surgical resection, and orbital exenteration, were used to achieve local control. CONCLUSIONS: Eyelid sebaceous carcinoma was found to exhibit epithelial involvement of the conjunctiva in 47% of cases, predominantly in the superior tarsal and fornical conjunctiva and less often in the inferior tarsal conjunctiva, caruncle, and cornea. Treatment of this condition is challenging, and map biopsy, cryotherapy, topical chemotherapy, and newer surgical methods are being used more often by our group.
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topical mitomycin c for extensive recurrent Conjunctival corneal squamous cell carcinoma
American Journal of Ophthalmology, 2002Co-Authors: Carol L Shields, Masood Naseripour, Jerry A ShieldsAbstract:Abstract PURPOSE: To evaluate the efficacy of topical mitomycin C for extensive recurrent Conjunctival and corneal squamous cell carcinoma (SCC). DESIGN: Interventional case series METHODS: A prospective study was conducted in a single institution. Ten patients (ten eyes) with extensive recurrent Conjunctival and corneal SCC were studied. The patients received topical mitomycin C 0.04% one drop four times daily in the eye with SCC. Treatment cycles were defined as 1 week using medication followed by 1 week without medication. Such treatment cycles were repeated until resolution of the Conjunctival malignancy was clinically evident. The main outcome measures were tumor response and medication-related complications. RESULTS: Of the ten patients, the median age was 66 years (range 33–77 years). Before referral, the patients had undergone a median of two previous Conjunctival tumor resections revealing the diagnosis of in situ SCC in three cases and locally invasive SCC in six cases. At presentation, the tumor involved the limbus and cornea in all ten eyes, forniceal conjunctiva in three eyes, and tarsal conjunctiva in one eye. The extensive tumor affected a median of 10 clock hours of limbal conjunctiva and 10 clock hours of cornea, with corneal epithelial invasion for a median of 50% (range 20%–100%) of its surface. Mitomycin C 0.04% four times daily was applied for a median of three cycles (range 1–4 cycles). Complete tumor regression was documented in all ten cases (100%). There was no recurrence over a mean follow up of 22 months (range 6–50 months). Mitomycin C caused moderate temporary local irritation and Conjunctival erythema and chemosis, but no long-term intraocular or extraocular complications. CONCLUSIONS: Based on this small series, topical mitomycin C 0.04% appears to be a safe and effective therapy for Conjunctival or corneal SCC, even when there is extensive recurrent tumor.
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surgical management of Conjunctival tumors the 1994 lynn b mcmahan lecture
Archives of Ophthalmology, 1997Co-Authors: Jerry A Shields, Carol L Shields, P De PotterAbstract:To our knowledge, there are no articles that describe the specific step-by-step details of the surgical removal of premalignant and malignant Conjunctival tumors. We describe our current approach to the surgical management of squamous cell carcinoma (intraepithelial or invasive), localized melanoma, and primary acquired melanosis of the conjunctiva. The surgical method differs with limbal tumors, extralimbal tumors, and primary acquired melanosis. Limbal lesions are managed by localized alcohol corneal epitheliectomy, removal of the main mass by a partial lamellar scleroconjunctivectomy, and supplemental cryotherapy. Tumors located in the extralimbal conjunctiva are managed by alcohol application, wide circumferential surgical resection, and cryotherapy. Primary acquired melanosis is managed by alcohol epitheliectomy, removal of suspicious foci, quadrantic staging biopsies, and cryotherapy from the underside of the conjunctiva. In all cases, a "no touch" method is used and direct manipulation of the tumor is avoided to prevent tumor cell seeding into a new area. We have employed this technique on 109 patients with Conjunctival squamous neoplasms and 137 patients with Conjunctival melanoma, about 80 of which neoplasms were associated with primary acquired melanosis. Our observations suggest that well-planned initial surgical management using this technique decreases the chance of tumor recurrence for Conjunctival melanoma and squamous cell carcinoma. We describe a detailed stepwise approach to the surgical management of Conjunctival neoplasms. It requires meticulous clinical evaluation and complete removal of the tumor in one operation using a specific technique.
Anselm Kampik - One of the best experts on this subject based on the ideXlab platform.
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Differences in basement membrane zone components of normal conjunctiva, conjunctiva in glaucoma and normal skin
Acta Ophthalmologica, 2012Co-Authors: Elisabeth M Messmer, Véronique M. Valet, Anselm KampikAbstract:Purpose: To describe the distribution of basement membrane zone (BMZ) components in normal conjunctiva, conjunctiva of patients with glaucoma and normal skin. Methods: Thirty-five normal Conjunctival biopsies and 16 Conjunctival biopsies of patients with glaucoma under topical anti-glaucomatous therapy were examined by immunohistochemistry. Antibodies were directed against laminin a chains, laminin subchains a1, a2, a3, b1, b3, c1, c2, c3, kalinin, b4-integrin, and collagens IV and VII. Results were compared to the antigen distribution at the BMZ in normal skin. Results: The BMZ of skin stained positive for all antibodies tested. In contrast to skin, the BMZ of normal conjunctiva was negative for laminin subunits a2, b1, b3, c 2a ndc3 in most or all specimens. Positive findings at the Conjunctival BMZ of patients with glaucoma were comparable to normal conjunctiva for laminin a, a1, b3, c1, c3, laminin 5, b4-integrin, collagen IV and collagen VII. However, staining of the BMZ with antibodies to laminin b1 (p = 0.002) and c2 (p = 0.017) was seen in a significantly higher rate in glaucoma compared to controls. Conclusion: Characteristic differences exist in the antigenicity of the BMZ in normal skin, normal conjunctiva and conjunctiva from patients with glaucoma, especially for laminin subchains. These differences may explain the variable ocular involvement in diseases of the BMZ. Moreover, they may explain the susceptibility of patients with glaucoma to develop mucous membrane pemphigoid-like disease. Alterations in Conjunctival BMZ in glaucoma may be induced by longterm topical anti-glaucoma medications including various preservation agents.
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in vivo confocal microscopy of normal conjunctiva and conjunctivitis
Cornea, 2006Co-Authors: Elisabeth M Messmer, Marc J Mackert, D M Zapp, Anselm KampikAbstract:Purpose: To analyze the appearance of normal conjunctiva and Conjunctival inflammation by in vivo confocal microscopy. Methods: Conjunctiva of 15 normal patients and 21 patients with conjunctivitis including bacterial, papillary, follicular, granulomatous, and cicatrizing disease were analyzed by the Heidelberg retina tomograph (HRTII)/Rostock cornea modul (RCM). Results: Scans of normal bulbar and tarsal conjunctiva corresponded well to the established anatomy except for a prominent, thickened epithelial basement membrane observed by in vivo microscopy. Presumed goblet cells were visible throughout the Conjunctival epithelium. Adenoid structures and hair follicles were discernible in the tarsal conjunctiva in vivo. Conjunctival perfusion could be observed directly. Acute and chronic inflammatory cells, Conjunctival papillary, and follicular reactions, as well as Conjunctival cicatrization, could be discriminated. In a patient with Conjunctival granuloma, in vivo confocal microscopy disclosed suture material inside the lesion. Conclusion: Confocal microscopy using near-infrared laser light is a useful new tool in the analysis of Conjunctival tissue in vivo. It is a valuable aid in the differential diagnosis of Conjunctival inflammation and thus may guide therapeutical decisions.
Nathan Efron - One of the best experts on this subject based on the ideXlab platform.
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confocal microscopy of the bulbar conjunctiva in contact lens wear
Cornea, 2010Co-Authors: Nathan Efron, Munira Aldossari, Nicola PritchardAbstract:Purpose: The aim of this study was to investigate the capabilities of laser scanning confocal microscopy (LSCM) for undertaking qualitative and quantitative investigations of the response of the bulbar conjunctiva to contact lens wear. Methods: LSCM was used to observe and measure morphological characteristics of the bulbar conjunctiva of 11 asymptomatic soft contact lens wearers and 11 healthy volunteer subjects (controls). Results: The appearance of the bulbar conjunctiva is consistent with known histology of this tissue based on light and electron microscopy. The thickness of the bulbar Conjunctival epithelium of lens wearers (30.9 ± 1.1 μm) was less than that of controls (32.9 ± 1.1 μm) (P < 0.0001). Superficial and basal bulbar Conjunctival epithelial cell densities in contact lens wearers were 91% and 79% higher, respectively, than that in controls (P < 0.0001). No difference was observed in goblet and Langerhans cell density between lens wearers and controls. Conjunctival microcysts were observed in greater numbers, and were larger in size, in lens wearers compared with controls. Conclusions: The effects of contact lens wear on the human bulbar conjunctiva can be investigated effectively at a cellular level using LSCM. The observations in this study suggest that contact lens wear can induce changes in the bulbar conjunctiva such as epithelial thinning and accelerated formation and enlargement of microcysts, increased epithelial cell density, but has no impact on goblet or Langerhans cell density.
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In vivo confocal microscopy of the bulbar conjunctiva
Clinical and Experimental Ophthalmology, 2009Co-Authors: Nathan Efron, Munira Al-dossari, Nicola PritchardAbstract:Background: The aim of this work is to develop a more complete qualitative and quantitative understanding of the in vivo histology of the human bulbar conjunctiva. Methods: Laser scanning confocal microscopy (LSCM) was used to observe and measure morphological characteristics of the bulbar conjunctiva of 11 healthy human volunteer subjects. Results: The superficial epithelial layer of the bulbar conjunctiva is seen as a mass of small cell nuclei. Cell borders are sometimes visible. The light grey borders of basal epithelial cells are clearly visible, but nuclei can not be seen. The Conjunctival stroma is comprised of a dense meshwork of white fibres, through which traverse blood vessels containing cellular elements. Orifices at the epithelial surface may represent goblet cells that have opened and expelled their contents. Goblet cells are also observed in the deeper epithelial layers, as well as Conjunctival microcysts and mature forms of Langerhans cells. The bulbar conjunctiva has a mean thickness of 32.9 ± 1.1 µm, and a superficial and basal epithelial cell density of 2212 ± 782 and 2368 ± 741 cells/mm2, respectively. Overall goblet and mature Langerhans cell densities are 111 ± 58 and 23 ± 25 cells/mm2, respectively. Conclusions: LSCM is a powerful technique for studying the human bulbar conjunctiva in vivo and quantifying key aspects of cell morphology. The observations presented here may serve as a useful marker against which changes in Conjunctival morphology due to disease, surgery, drug therapy or contact lens wear can be assessed.
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In Vivo Confocal Microscopy of the Bubar Conjunctiva
Clinical and Experimental Ophthalmology, 2009Co-Authors: Nathan Efron, Munira Al-dossari, Nicola PritchardAbstract:Background: The aim of this work is to develop a more complete qualitative and quantitative understanding of the in vivo histology of the human bulbar conjunctiva. Methods: Laser scanning confocal microscopy (LSCM) was used to observe and measure morphological characteristics of the bulbar conjunctiva of 11 healthy human volunteer subjects. Results: The superficial epithelial layer of the bulbar conjunctiva is seen as a mass of small cell nuclei. Cell borders are sometimes visible. The light grey borders of basal epithelial cells are clearly visible, but nuclei can not be seen. The Conjunctival stroma is comprised of a dense meshwork of white fibres, through which traverse blood vessels containing cellular elements. Orifices at the epithelial surface may represent goblet cells that have opened and expelled their contents. Goblet cells are also observed in the deeper epithelial layers, as well as Conjunctival microcysts and mature forms of Langerhans cells. The bulbar conjunctiva has a mean thickness of 32.9 1.1 mm, and a superficial and basal epithelial cell density of 2212 782 and 2368 741 cells/ mm2, respectively. Overall goblet and mature Langerhans cell densities are 111 58 and 23 25 cells/mm2, respectively. Conclusions: LSCM is a powerful technique for studying the human bulbar conjunctiva in vivo and quantifying key aspects of cell morphology. The observations presented here may serve as a useful marker against which changes in Conjunctival morphology due to disease, surgery, drug therapy or contact lens wear can be assessed.
Carol L Shields - One of the best experts on this subject based on the ideXlab platform.
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Conjunctival amyloidosis report of six cases and review of the literature
Survey of Ophthalmology, 2006Co-Authors: Hakan Demirci, Carol L Shields, Ralph C Eagle, Jerry A ShieldsAbstract:Conjunctival amyloidosis is an uncommon condition that occasionally is associated with systemic involvement. The clinical presentations of Conjunctival amyloidosis are diverse. We present six patients with Conjunctival amyloidosis who were referred to us with the suspicion of another Conjunctival lesion. The Conjunctival lesion was circumscribed in two patients and diffuse in four patients. The lesion color was yellow in one patient and yellow-pink in five patients. The associated features were intrinsic vascularization (six patients), recurrent subConjunctival hemorrhage (four patients) and blepharoptosis that involved the palpebral conjunctiva (two patients). Systemic evaluation revealed primary systemic amyloidosis in one patient and no related systemic abnormalities in five patients. Management consisted of complete excisional biopsy for the two circumscribed lesions and incisional biopsy for the four diffuse lesions. Two patients with diffuse involvement showed progressive involvement of the conjunctiva over 3 years following incisional biopsy and the other four patients remained stable. Additionally, there was no systemic involvement in five patients. In conclusion, Conjunctival amyloidosis generally manifests as a yellowish-pink, hemorrhagic mass deep to the epithelium. Most patients show no evidence of systemic amyloidosis.
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Conjunctival epithelial involvement by eyelid sebaceous carcinoma the 2003 j howard stokes lecture
Ophthalmic Plastic and Reconstructive Surgery, 2005Co-Authors: Jerry A Shields, Hakan Demirci, Brian P Marr, Ralph C Eagle, Mary A Stefanyszyn, Carol L ShieldsAbstract:PURPOSE: To determine incidence and distribution of Conjunctival epithelial involvement by eyelid sebaceous carcinoma and to make recommendations regarding its management. METHODS: The medical records were reviewed retrospectively on patients with histopathologically confirmed sebaceous carcinoma of the eyelids managed at the Oncology Service at Wills Eye Hospital. Those tumors with involvement of the Conjunctival epithelium were identified and selected for further study. The incidence and distribution of epithelial involvement was determined, based on histopathology of resected tumors and map biopsies. The incidence of metastasis and tumor-related mortality was determined. Based on these findings and personal surgical experience, recommendations are made regarding management of eyelid sebaceous carcinoma with involvement of the Conjunctival epithelium. RESULTS: Of 60 patients with sebaceous carcinoma, epithelial involvement of the conjunctiva was identified in 28 (47%). Of the 28 cases, the neoplasm affected the following sites: superior tarsal and fornical conjunctiva in 28 (100%), inferior tarsal conjunctiva in 19 (68%), inferior fornical conjunctiva in 18 (64%), superior bulbar conjunctiva in 19 (68%), and inferior bulbar conjunctiva in 16 (57%). The caruncle was involved in 15 (54%) and the cornea in 11 (39%). Metastasis occurred in 3 of the 28 cases (11%). Map biopsies, combined with cryotherapy, topical chemotherapy, local surgical resection, and orbital exenteration, were used to achieve local control. CONCLUSIONS: Eyelid sebaceous carcinoma was found to exhibit epithelial involvement of the conjunctiva in 47% of cases, predominantly in the superior tarsal and fornical conjunctiva and less often in the inferior tarsal conjunctiva, caruncle, and cornea. Treatment of this condition is challenging, and map biopsy, cryotherapy, topical chemotherapy, and newer surgical methods are being used more often by our group.
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topical mitomycin c for extensive recurrent Conjunctival corneal squamous cell carcinoma
American Journal of Ophthalmology, 2002Co-Authors: Carol L Shields, Masood Naseripour, Jerry A ShieldsAbstract:Abstract PURPOSE: To evaluate the efficacy of topical mitomycin C for extensive recurrent Conjunctival and corneal squamous cell carcinoma (SCC). DESIGN: Interventional case series METHODS: A prospective study was conducted in a single institution. Ten patients (ten eyes) with extensive recurrent Conjunctival and corneal SCC were studied. The patients received topical mitomycin C 0.04% one drop four times daily in the eye with SCC. Treatment cycles were defined as 1 week using medication followed by 1 week without medication. Such treatment cycles were repeated until resolution of the Conjunctival malignancy was clinically evident. The main outcome measures were tumor response and medication-related complications. RESULTS: Of the ten patients, the median age was 66 years (range 33–77 years). Before referral, the patients had undergone a median of two previous Conjunctival tumor resections revealing the diagnosis of in situ SCC in three cases and locally invasive SCC in six cases. At presentation, the tumor involved the limbus and cornea in all ten eyes, forniceal conjunctiva in three eyes, and tarsal conjunctiva in one eye. The extensive tumor affected a median of 10 clock hours of limbal conjunctiva and 10 clock hours of cornea, with corneal epithelial invasion for a median of 50% (range 20%–100%) of its surface. Mitomycin C 0.04% four times daily was applied for a median of three cycles (range 1–4 cycles). Complete tumor regression was documented in all ten cases (100%). There was no recurrence over a mean follow up of 22 months (range 6–50 months). Mitomycin C caused moderate temporary local irritation and Conjunctival erythema and chemosis, but no long-term intraocular or extraocular complications. CONCLUSIONS: Based on this small series, topical mitomycin C 0.04% appears to be a safe and effective therapy for Conjunctival or corneal SCC, even when there is extensive recurrent tumor.
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surgical management of Conjunctival tumors the 1994 lynn b mcmahan lecture
Archives of Ophthalmology, 1997Co-Authors: Jerry A Shields, Carol L Shields, P De PotterAbstract:To our knowledge, there are no articles that describe the specific step-by-step details of the surgical removal of premalignant and malignant Conjunctival tumors. We describe our current approach to the surgical management of squamous cell carcinoma (intraepithelial or invasive), localized melanoma, and primary acquired melanosis of the conjunctiva. The surgical method differs with limbal tumors, extralimbal tumors, and primary acquired melanosis. Limbal lesions are managed by localized alcohol corneal epitheliectomy, removal of the main mass by a partial lamellar scleroconjunctivectomy, and supplemental cryotherapy. Tumors located in the extralimbal conjunctiva are managed by alcohol application, wide circumferential surgical resection, and cryotherapy. Primary acquired melanosis is managed by alcohol epitheliectomy, removal of suspicious foci, quadrantic staging biopsies, and cryotherapy from the underside of the conjunctiva. In all cases, a "no touch" method is used and direct manipulation of the tumor is avoided to prevent tumor cell seeding into a new area. We have employed this technique on 109 patients with Conjunctival squamous neoplasms and 137 patients with Conjunctival melanoma, about 80 of which neoplasms were associated with primary acquired melanosis. Our observations suggest that well-planned initial surgical management using this technique decreases the chance of tumor recurrence for Conjunctival melanoma and squamous cell carcinoma. We describe a detailed stepwise approach to the surgical management of Conjunctival neoplasms. It requires meticulous clinical evaluation and complete removal of the tumor in one operation using a specific technique.
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metastatic tumours to the conjunctiva report of 10 cases
British Journal of Ophthalmology, 1996Co-Authors: H Kiratli, Carol L Shields, Jerry A Shields, P DepotterAbstract:AIMS/BACKGROUND: Ten patients with metastatic tumours to the conjunctiva and the clinical aspects of this rare form of ocular metastasis are described in this study. METHOD: All patients with ocular and adnexal metastatic tumours referred to an ocular oncology service were reviewed and those having Conjunctival metastases were studied for the site of their primary tumour, clinical features, and treatment of the Conjunctival tumour, associated ocular and systemic findings, and the patients' outcome. RESULTS: The primary malignancy was carcinoma of the breast in four, lung cancer in two, laryngeal carcinoma in one, cutaneous melanoma in two, and unknown in one patient. The Conjunctival metastases appeared after the primary tumour over a mean period of 44 (8-130) months. They were solitary in eight cases, located in bulbar conjunctiva in six, palpebral conjunctiva in two, and in limbus and forniceal conjunctiva in one patient each. The tumour was yellow in colour in seven patients, red in two, and brown in one. Eight patients also had metastases to other ocular structures. Seven patients received external beam radiotherapy to the affected eye, two were managed by excisional biopsy, and one with chemotherapy. The mean survival after the diagnosis of Conjunctival metastasis was nine (range 2-26) months. CONCLUSION: Metastatic tumours to the conjunctiva appear at an advanced stage of the systemic disease when there are other ocular and organ metastases. The presence of a Conjunctival mass in a patient with a prior systemic cancer should alert the ophthalmologist to the possibility of a Conjunctival metastasis and evaluation should be pursued.