RETINOBLASTOMA is the most common malignant intraocular tumor in children; it is also one of the most highly curable pediatric solid tumors if detected early. The conventional treatment of retinoblastoma is primary enucleation. Recent research reported a trend toward decreasing frequency of enucleation in the management of retinoblastoma. The trend toward globe-sparing interventions has been largely attributed to earlier diagnosis and recent success with conservative globe-sparing treatment options. Currently, globe-sparing interventions include first-line chemotherapy or chemoreduction, subconjunctival chemotherapy, systemic chemotherapy for metastasis, transpupillary thermotherapy (TIT), chemothermotherapy (CTT), laser photocoagulation, cryotherapy, brachytherapy, and external beam radiotherapy (EBRT). Expanded clinical options currently available have markedly decreased the overall enucleation rate for retinoblastoma CLINICAL SCENARIO: A 10-month old boy is brought to an ophthalmologist because of cats eye reflex in the left eye. The patient had undergone enucleation of his right eye for glaucomatous stage retinoblastoma 6 months earlier. Examination revealed the presence of a solitary retinal mass of about 12 mm in diameter, located nasal to the disc. There was no evidence of vitreous seeding Realizing that this was the only eye of the patient, the ophthalmologist wants to do everything humanly possible to preserve it. He has heard about chemothermotherapy (CTT) but is not sure if this was the best alternative he can offer CLINICAL QUESTION: Among patients with retinoblastoma, is chemoreduction combined with adjuvant treatment effective in preserving the globe and vision? (Author)
EYE ENUCLEATION

Purpose: To determine the effect of phacoemulsification on the progression of diabetic retinopathy. Methods: We conducted an electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 1, 2005), MEDLINE, and the reference lists of identified trials evaluating the effects of phacoemulsification on the progression of diabetic retinopathy. There were no language or date restrictions in the electronic search. Two reviewers independently assessed the articles for inclusion. Odds ratio at 95 percent confidence interval was determined using Review Manager 4.2.2 (The Cochrane Collaboration, Oxford, United Kingdom). Results: No randomized controlled trials were found. Five non randomized, prospective, case-controlled trials involving a total of 804 eyes were included in this review. All 5 trials studied the effects of phacoemulsification on the progression of diabetic retinopathy using the fellow nonoperated eye as control. Pooled analysis showed weak evidence to support the progression of diabetic retinopathy (RR=1.36: 95 percent; CI 0.95-1.96) in eyes that underwent phacoemulsification compared with eyes that did not. Conclusion: The available literature consists mainly of retrospective case reviews and case-controlled trials that are difficult to compare and analyze due to variations in the definition of progression and retinopathy assessment and surgical technique. However, the 5 studies reviewed show that uncomplicated phacoemulsification had minimal or no effect on the progression of diabetic retinopathy. Further randomized, controlled trials are needed to confirm this finding.
DIABETIC RETINOPATHY ; PHACOEMULSIFICATION ; META-ANALYSIS ; RETROSPECTIVE STUDIES

OBJECTIVE: To determine the psychological profile of Filipino patients diagnosed with central serous retinopathy (CSR).
METHODOLOGY: Patients seen at the Philippine General Hospital and diagnosed with CSR were included in the study after undergoing an eye evaluation. They completed a data collection form and the Minnesota Multiphasic Personality Inventory (MMPI) questionnaire that was administered by a psychologist. The results of the MMPI were analyzed against an available normative scale. The socio-demographic data and patients' psychological profile were determined.
RESULTS: The study population (N=12) included 10 males (83%) and 2 females (17%), with a mean age of 38 ± 8.58 years. Eighty three percent (83%) of the patients lived at home with their families. All (100%) had some formal education; 58% attended or completed high school. The majority (75%) worked in non-professional roles (cooks, drivers, seaman, salesman) and 25% were not working. Most (67%) had no other medical illnesses. In the MMPI, the CSR patients showed tendencies to schizophrenia (84%), hysteria (83%), depression (75%), psychopathic deviate (67%), and hypochondriasis (58%).
CONCLUSION: The socio-demographic data confirmed that CSR is an ailment largely affecting middle-aged men. The sample population of Filipino CSR patients have the tendency to demonstrate schizophrenia (84%), hysteria (83%), depression (75%), and psychopathic deviate (67%), and 33% showed type A personality.

Human ; Male ; Female ; Middle Aged ; Adult ; Hysteria ; Mmpi ; Hypochondriasis ; Depression ; Type A Personality ; Central Serous Chorioretinopathy ; Depressive Disorder ; Schizophrenia

OBJECTIVE: To correlate glycemic control, as expressed by HbA1c levels, to the change in macular thickness in diabetic patients who undergo phacoemulsification.

METHODS: This was a prospective cohort study done at the Cataract and Medical Retina Clinics of the University of the Philippines Department of Ophthalmology and Visual Sciences (UP-DOVS), Sentro Oftalmologico Jose Rizal (SOJR) of the Philippine General Hospital, University of the Philippines - Manila. Participants included 15 diabetic patients with mature cataracts that warranted lens extraction surgery via phacoemulsification by a senior resident of the UP-DOVS. Participants were screened using pre-determined inclusion and exclusion criteria. Pre-operative best corrected visual acuity (BCVA) was obtained for both eyes using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Pre-operative central macular thickness (CMT) was measured using the Cirrus Ocular Coherence Tomography (OCT) machine. Patients then underwent monocular phacoemulsification by their respective surgeons and instilled antibiotic and steroid drops as instructed. One month after surgery, BCVA and post-operative CMTwere measured. Blood was extracted and sent for determination of glycosylated hemoglobin (HbA1c) levels. Ttest was done to compare the mean CMT and BCVA at baseline and at 1 month after phacoemulsification in the study and control eyes. T-test was also used to compare the mean change in CMT in the study and control eyes. Simple correlation between HbA1c and CMT, as well as CMT and BCVA, was done using Pearson's R.

RESULTS: Neither mean baseline nor mean post-operative CMT between study and control eyes were statistically different  and p=0.1562). There was a statistically significant greater mean CMT in the study eye group (p=0.004). There was a mean change in CMT of 16.7 ± 18.5 ?m, and 1.8 ± 8.8 ?m in the group of control eyes (p=0.011). Mean HbA1c was 8.19%. No positive correlation was established between HbA1c and mean CMT in both study eyes (r=-0.312) and control eyes (r=-0.289). No correlation was established between BCVA and CMT (r=0.426).

CONCLUSION: In diabetics, eyes that undergo phacoemulsification gain a significant change in CMT but this may not necessarily result in macular edema and may not parallel the severity of diabetic retinopathy. We were not able to demonstrate correlation between CMT and HbA1c levels or CMT and BCVA.

Human ; Male ; Female ; Aged ; Middle Aged ; Macular Edema ; Diabetic Retinopathy ; Phacoemulsification ; Hemoglobin A, Glycosylated ; Ophthalmology ; Anti-bacterial Agents ; Cataract ; Retina ; Visual Acuity

OBJECTIVE: To investigate the significance of short wavelength automated perimetry (SWAP) in detecting retinal functional impairment in early diabetic patients without retinopathy and with mild non-proliferative diabetic retinopathy (NPDR).

METHODS: This is a prospective, cross-sectional study of 37 eyes of early diabetics which were divided into 2 groups: no DR with 18 subjects and mild NPDR with 19. All subjects underwent HBA1C, SWAP, peripapillary RNFL thickness measurement and fundus photo. Visual field indices: MD and PSD as well as average RNFL thickness were compared among the 2 groups. Correlation of MD with RNFL thickness and HBA1C were also analyzed.

RESULTS: There was no statistically significant difference in the MD (-4.46 ± 3.03 vs -2.94 ± 2.21; p=0.09), PSD (3.08 ± 1.28 vs 2.69 ± 0.47; p=0.23) and average peripapillary RNFL thickness (98.47 ± 6.89 vs 98.72 ± 11.01; p=0.93) among early diabetics with mild NPDR and no signs of DR. There is no correlation between MD and RNFL thickness in the no DR group (R2=0.017) and the mild DR group (R2=0.000). There was a weak correlation between MD and HBA1C in the no DR group (R2=0.137), while no correlation was seen in the mild NPDR group (R2=0.000).

CONCLUSION: SWAP does not appear to be a sensitive measure of worsening retinopathy in older individuals with early diabetes. The usefulness of SWAP and peripapillary RNFL thickness in the early stages of retinopathy are inconclusive.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Diabetic Retinopathy ; Visual Field Tests ; Visual Fields ; Retina ; Fundus Oculi ; Retinal Diseases

OBJECTIVE: To determine the incidence of contrast-induced nephropathy (CIN) among patients undergoing fundus fluorescein angiography (FFA) METHODS: One hundred fifty-nine (159) patients from the Ophthalmology out-patient department were enrolled in this prospective, observational study. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were measured within 7 days before and 48 to 72 hours after FFA. Subjects were stratified into low-, intermediate-, and high-risk groups for developing CIN according to baseline eGFR. CIN was defined by an increase in SCr by more than 25% or by 0.5 mg/dL within 72 hours of intravascular administration of contrast media. The incidence of CIN, changes in SCr levels, and changes in eGFR were analyzed. RESULTS: Of the 144 subjects who completed the study, 106 (73.6%) were females, 105 (72.9 %) were diabetics, and 57 (39.6%) had elevated baseline SCr. Four (4 or 2.8%) patients developed CIN after FFA, all of whom had normal baseline SCr and were stratified as low-risks. Overall, there were no significant changes in the means of SCr (1.18 ± 0.56 vs 1.16 ± 0.52, p = 0.13) and eGFR (64.53 ± 26.05 vs 64.94 ± 24.88, p = 0.64) before and after FFA. In the low-risk group, the means of SCr and eGFR remained unchanged after FFA (p = 0.06 and p = 0.15, respectively). In the intermediate-risk group, no significant change was appreciated in SCr levels (p = 0.07) however a significant improvement in eGFR (p = 0.006) was seen. Interestingly, a significant decrease in SCr levels (p = 0.004) as well as a significant improvement in eGFR (p = 0.02) was noted after FFA in the high-risk group. CONCLUSION: The incidence of CIN among patients undergoing FFA in our cohort was 2.8%. There was no prolonged or serious worsening of renal function based on SCr and eGFR before and after FFA overall, and among low-, moderate-, and high-risk groups.
Creatinine ; Glomerular Filtration Rate ; Contrast Media ; Incidence ; Fluorescein Angiography ; Acute Kidney Injury ; Drug-Related Side Effects and Adverse Reactions