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MOHS Microscopically Controlled Surgery: Should it be the Routine Surgical Treatment for Non-melanoma Periocular Malignancies?

Background: The periocular region is susceptible to numerous benign and malignant neoplasms. Periocular skin malignancies may present differently, behave more aggressively, and pose more management challenges than malignancies at other cutaneous sites. Extent of skin cancer is often difficult to assess prior to surgery. Microscopically controlled surgery (MCS) aims to assure complete removal of a malignancy with histological confirmation while preserving as much of the adjacent tissues as possible. This retrospective review distinguishes clinical-practice management trends in periocular nonmelanoma skin malignancies. Methods: Retrospective review of 37 medical records of patients with histology proven periocular nonmelanoma skin malignancies seen in Oculoplastic section of the Department of Ophthalmology at Hospital de l'Esperanca - Hospital del Mar between July 2010 and January 2017. Results: Global mean age was 72 with a male: female ratio of 1. Basal cell carcinoma was the most commonly excised tumor (81%) and lower eyelid the most common tumor location (54%) followed by medial canthus (38%). MCS was performed globally in 65% of cases. During 2011-2012 period 38% of malignancies were treated with MCS. MCS was performed in 73% of cases during 2013-2014 and 2015- 2016 periods. Mean horizontal excision size was 13 mm. Flap and flap and graft combination were the most frequent reparation types (24% each). Conclusions: Microscopically controlled surgery for the management of periocular malignancies has increased in our hospital during 2011-2016. It confirms histopathological diagnosis and free margins of excision allowing periocular reconstruction on the same day. Microscopically controlled surgery safes healthy tissues which are essential in the eyelid and it decreases patients’ morbidity.

Purpose. To present the outcomes of hybrid multifocal and monofocal intraocular lenses (IOLs) and to compare with refractive and diffractive multifocal IOLs (MFIOLs).Methods. Three hundred twenty eyes (160 patients) underwent cataract surgery with randomized IOLs bilateral implantation. Changes in uncorrected and distance-corrected logMAR distance, intermediate and near (UNVA and DCNVA) visual acuity (VA), contrast sensitivity (CS), presence of dysphotopsia, spectacle independence, and patient satisfaction were analyzed.Results. Postoperative VA in the hybrid (OptiVis) group was improved in all distances (p<0.001). OptiVis acted superiorly to monofocal IOLs in UNVA and DCNVA (p<0.001for both) and to refractive ones in DCNVA (p<0.005). Distance, mesopic, without glare CS in OptiVis was lower than in the monofocal group and similar to other MFIOLs. No differences in dysphotopsia pre- and postoperatively and spectacle independence in near for OptiVis and refractive MFIOLs were detected. OptiVis patients were more satisfied than those with monofocal IOLs (p=0.015).Conclusions. After cataract surgery, patients with OptiVis improved VA in all distances. Near and intermediate VA was better than monofocal, and DCNVA was better than the refractive group. CS was lower in OptiVis than in the monofocal group, but there was no difference between MFIOLs. Patient satisfaction was higher in OptiVis than in the monofocal group. This trial is registered withNCT03512626.

PURPOSE To evaluate the efficacy of photodynamic therapy (PDT) in a patient with juxtapapillary idiopathic polypoidal choroidal vasculopathy (IPCV) in the papillomacular bundle. METHODS One session of PDT using a spot size with diameter of 1000 μm in the center of the juxtapapillary lesion was applied. PATIENT A 75-year-old woman with decreased vision (20/80) in her right eye over a period of 1 year. RESULTS After a follow-up of 2 years, the best-corrected visual acuity was 20/32, the lesion remained sclerosed, and lipids have disappeared. CONCLUSION PDT represented a good treatment for this patient with juxtapapillary IPCV.

Lens-iris diaphragm retropulsion syndrome is mainly caused by a reverse pupillary block as a result of a defect or laxity in the zonular apparatus. It is characterized by a posterior displacement of the lens-iris diaphragm with posterior iris bowing, pupil dilation, and pain. The authors describe a new management technique using an iris hook retractor to lift the iris to relieve the pupillary block. [Ophthalmic Surg Lasers Imaging 2005;36:512-513.]