PURPOSE: To report the feasibility and safety profile of 2-mg and 6-mg fluoc inolone acetonide implants after longterm follow-up in eyes with choroidal neov ascularization (CNV)DESIGN: Prospective, noncomparative, int...PURPOSE: To report the feasibility and safety profile of 2-mg and 6-mg fluoc inolone acetonide implants after longterm follow-up in eyes with choroidal neov ascularization (CNV)DESIGN: Prospective, noncomparative, interventional case ser ies of patients with non-age-related subfoveal choroidal neovascularization en rolled in a compassionate use protocol METHODS: Sustained drug delivery devices containing either 2 mg (eight eyes) or 6 mg (six eyes) of fluocinolone acetonide were implanted through the pars plana into the vitreous cavity of 14 patients w ith predominantly classic, subfoveal CNV. The main outcome measures were complic ations related to the device. Secondary outcome measures were involution of esta blished CNV, inhibition of recurrent CNV, and visual acuity RESULTS: Patients ha d a diagnosis of ocular histoplasmosis (seven), myopic degeneration (four), angi oid streaks (two), and punctate inner choroidopathy (one). Patients were followe d for an average of 33 months (range, 16 to 40 months). All 14 eyes developed el evated intraocular pressure and cataract. Four eyes developed nonischemic centra l retinal vein occlusion. Complications required implant removal in 8 eyes. Ten of 14 eyes demonstrated involution of CNV or inhibition of recurrent CNV. Ten ey es had stable or improved visual acuity. Median initial visual acuity was 20/64. Median final visual acuity was 20/40 CONCLUSIONS: Longterm follow-up demonstra tes a significant complication rate with the sustained release of high-dose int raocular corticosteroids. The complications are treatable, and eyes can retain g ood vision. This therapeutic approach warrants further study to identify if lowe r doses of corticosteroids may reduce the complication rate yet still be effecti ve in treating ocular disease.展开更多
Rosai- Dorfman Disease (RDD) is an idiopathic reactive proliferation of distinctive histiocytes that have abundant cytoplasm and commonly exhibit intracytoplasmic ingestion of inflammatory cells (emperipolesis). The h...Rosai- Dorfman Disease (RDD) is an idiopathic reactive proliferation of distinctive histiocytes that have abundant cytoplasm and commonly exhibit intracytoplasmic ingestion of inflammatory cells (emperipolesis). The histiocytes are immunopositive for S100 protein and are typically associated with an infiltrate of lymphocytes, plasma cells, and neutrophils. The classic clinical presentation is massive enlargement of (usually) cervical lymph nodes with a histologic appearance that mimics exaggerated sinus histiocytosis. RDD can also involve extranodal sites and skin involvement is common either as part of disseminated disease or as a result of primary disease. We report an exceptional case of cutaneous RDD with crystal deposition in a young male presenting with skin nodules. Skin biopsy showed classic features of cutaneous RDD with the additional feature of conspicuous rhomboidal and needle- shaped crystals within the cytoplasm of many lesional plasma cells, histiocytes, and also in an extracellular location. The plasma cells were polyclonal by light chain immunostaining. Crystal deposition has not been reported to date in RDD and is likely a result of the reactive plasma cell proliferation.展开更多
文摘PURPOSE: To report the feasibility and safety profile of 2-mg and 6-mg fluoc inolone acetonide implants after longterm follow-up in eyes with choroidal neov ascularization (CNV)DESIGN: Prospective, noncomparative, interventional case ser ies of patients with non-age-related subfoveal choroidal neovascularization en rolled in a compassionate use protocol METHODS: Sustained drug delivery devices containing either 2 mg (eight eyes) or 6 mg (six eyes) of fluocinolone acetonide were implanted through the pars plana into the vitreous cavity of 14 patients w ith predominantly classic, subfoveal CNV. The main outcome measures were complic ations related to the device. Secondary outcome measures were involution of esta blished CNV, inhibition of recurrent CNV, and visual acuity RESULTS: Patients ha d a diagnosis of ocular histoplasmosis (seven), myopic degeneration (four), angi oid streaks (two), and punctate inner choroidopathy (one). Patients were followe d for an average of 33 months (range, 16 to 40 months). All 14 eyes developed el evated intraocular pressure and cataract. Four eyes developed nonischemic centra l retinal vein occlusion. Complications required implant removal in 8 eyes. Ten of 14 eyes demonstrated involution of CNV or inhibition of recurrent CNV. Ten ey es had stable or improved visual acuity. Median initial visual acuity was 20/64. Median final visual acuity was 20/40 CONCLUSIONS: Longterm follow-up demonstra tes a significant complication rate with the sustained release of high-dose int raocular corticosteroids. The complications are treatable, and eyes can retain g ood vision. This therapeutic approach warrants further study to identify if lowe r doses of corticosteroids may reduce the complication rate yet still be effecti ve in treating ocular disease.
文摘Rosai- Dorfman Disease (RDD) is an idiopathic reactive proliferation of distinctive histiocytes that have abundant cytoplasm and commonly exhibit intracytoplasmic ingestion of inflammatory cells (emperipolesis). The histiocytes are immunopositive for S100 protein and are typically associated with an infiltrate of lymphocytes, plasma cells, and neutrophils. The classic clinical presentation is massive enlargement of (usually) cervical lymph nodes with a histologic appearance that mimics exaggerated sinus histiocytosis. RDD can also involve extranodal sites and skin involvement is common either as part of disseminated disease or as a result of primary disease. We report an exceptional case of cutaneous RDD with crystal deposition in a young male presenting with skin nodules. Skin biopsy showed classic features of cutaneous RDD with the additional feature of conspicuous rhomboidal and needle- shaped crystals within the cytoplasm of many lesional plasma cells, histiocytes, and also in an extracellular location. The plasma cells were polyclonal by light chain immunostaining. Crystal deposition has not been reported to date in RDD and is likely a result of the reactive plasma cell proliferation.
