Epidemio-Clinical-Histopathological Aspects and Therapeutics of Squamous Cell Carcinoma of the Conjunctival at the University Hospital Center of Bouake

Introduction: Squamous cell carcinoma of the conjunctiva is one of the most common malignancies in the elderly. Purpose: To describe the specific aspects of squamous cell carcinoma of the conjunctiva and to determine the therapeutic modalities. Materials and Methods: Descriptive cross-sectional retrospective study carried out at the University Hospital Center of Bouake over a period of 9 years (From January 2015 to December 2023). We identified all malignant oculo-adnexal and orbital tumors whose histopathological diagnosis was confirmed;monitoring the sorting of squamous cell carcinomas of the conjunctiva among these cancers and studying the different parameters linked to them. Results: The average age of patients is 44.3 years. Male predominance with a sex ratio of 1.12. HIV was the majority ATCD with 64.7%. The main reason for consultation was exophthalmos (36.11%). The average consultation time was 10 months 13 days. Invasive differentiated conjunctival squamous cell carcinoma was predominant at 55.56%. Enucleation was the most performed surgical method. Conclusion: Squamous cell carcinoma of the conjunctiva is a malignant ocular tumor of the elderly whose frequency increases in young adults infected with HIV-AIDS. Invasive differentiated forms are increasingly encountered, limiting treatment to mutilating surgery.

Primary anaplastic lymphoma kinase-positive large B-cell lymphoma of the left bulbar conjunctiva: A case report

BACKGROUND Anaplastic lymphoma kinase(ALK)-positive large B-cell lymphoma(LBCL)is an aggressive and rare variant of diffuse LBCL.Herein,we report an uncommon case of stage IE extranodal ALK-positive LBCL initially originating in the bulbar con-junctiva.CASE SUMMARY A 63-year-old woman presented with a mass in the left bulbar conjunctiva that had persisted for six months,accompanied by swelling and pain that had per-sisted for 3 d.Eye examination revealed an 8 mm slightly elevated pink mass in the lower conjunctival sac of the left eye.Microscopically,the tumor was com-posed of large immunoblastic and plasmablastic large lymphoid cells with scattered anaplastic or multinucleated large cells.Immunophenotypically,the neoplastic cells were positive for ALK,CD10,CD138,Kappa,MUM1,BOB.1,OCT-2,CD4,CD45,EMA,CD79a,CD38,and AE1/AE3,and negative for CD20,PAX5,Lambda,BCL6,CD30 and all other T-cell antigens.The results of gene rearrangement tests showed monoclonal IGH/IGK/IGL and TCRD rearran-gements.Fluorescence in situ hybridization studies did not reveal any BCL2,BCL6 or MYC rearrangements.Furthermore,Epstein-Barr virus was not detected by in situ hybridization in the lesions.Based on the histopathological and imaging examinations,the neoplasm was classified as stage IE ALK-positive LBCL.No further treatments were administered.At the 6,15,and 21 mo postoperative follow-up visits,the patient was in good condition,without obvious discomfort.This case represents the first example of primary extranodal ALK-positive LBCL presenting as a bulbar conjunctival mass,which is extremely rare and shares morphological and immunohistochemical features with a variety of other neo-plasms that can result in misdiagnosis.CONCLUSION Awareness of the condition presented in this case report is necessary for early and accurate diagnosis and appropriate treatment.

电针对干眼大鼠结膜NLRP3炎症小体及相关蛋白的作用研究

目的从调节大鼠眼表功能及结膜组织中NOD样受体热蛋白结构域3(NOD-like receptor pyrin domain containing 3,NLRP3)炎症小体及相关蛋白角度探讨电针对干眼(Dry eye,DE)大鼠的作用。方法将32只雄性SD大鼠随机分为正常组、模型组、电针组和假电针组4组,每组各8只。采用氢溴酸东莨菪碱皮下注射结合吹风法制备DE模型。造模成功后电针组取双侧“丝竹空”“风池”穴进行电针干预,每日1次,每次20 min。假电针组取穴同电针组,穴位连接电针但不通电。两组各干预7 d。检测各组干预前后的泪液分泌量、泪膜破裂时间;观察结膜组织病理学变化;采用Western blot和免疫组化法检测结膜组织中NLRP3、凋亡相关斑点样蛋白(apoptosis-associated speck-like protein containing a CARD,ASC)、半胱天冬酶(Caspase)-1、白细胞介素(interleukin,IL)-1β、IL-18蛋白表达的变化。结果与正常组比较,模型组泪液分泌量和泪膜破裂时间显著降低(P<0.05),结膜组织中NLRP3、ASC、Caspase-1、IL-1β、IL-18蛋白表达均升高(P<0.05);与模型组比较,电针组泪液分泌量和泪膜破裂时间均显著升高(P<0.05),结膜组织中NLRP3、ASC、Caspase-1、IL-1β、IL-18蛋白表达均降低(均P<0.01);且电针组IL-1β和IL-18蛋白表达较假电针组均显著降低(P<0.05)。结论电针能改善DE大鼠的眼表功能,下调结膜NLRP3炎症小体及下游炎性因子IL-1β、IL-18的表达。电针可能通过抑制NLRP3炎症小体信号通路减轻DE大鼠眼表炎症。

结膜黑色素瘤组织中S100A4蛋白表达及其预后预测价值

目的探究结膜黑色素瘤组织中S100A4蛋白表达及其预后预测价值。方法选取2021年1月至2023年1月于灵宝市福寿堂眼科医院、郑州大学第一附属医院接受手术治疗的56例结膜黑色素瘤患者为研究对象。采用免疫组化法S-P法检测S100A4蛋白在结膜黑色素瘤组织中的表达,根据检测结果将入组患者分为S100A4蛋白高表达组(n=35)和S100A4蛋白低表达组(n=21),比较S100A4表达与总生存时间的关系。依据结膜黑色素瘤患者的预后情况将入组患者分为预后良好组(n=18)、预后不良组(n=38),分析可能影响结膜黑色素瘤患者预后不良的危险因素,根据危险因素构建Logistic回归预测模型,采用受试者工作特征曲线评估该预测模型效能。结果结膜黑色素瘤患者中位总生存时间为10个月,术后1 a存活率为80.36%(45/56)。S100A4蛋白高表达组患者中位生存时间、术后1 a生存率(9个月,74.58%)均低于S100A4蛋白低表达组(10个月,90.47%;Log-rankχ^(2)=3.485,P=0.001)。预后不良组患者肿瘤低分化、淋巴结转移、S100A4蛋白高表达比例分别为68.42%、73.68%、71.05%,均高于预后良好组的22.22%、27.78%、22.22%(χ^(2)=10.481,P=0.001;χ^(2)=10.635,P=0.001;χ^(2)=11.785,P=0.001)。多因素Logistic回归分析结果显示,肿瘤低分化(OR=2.042,95%CI:1.350~2.734)、淋巴结转移(OR=1.876,95%CI:1.225~2.526)、S100A4蛋白高表达(OR=1.828,95%CI:1.354~2.301)是影响黑色素瘤患者预后的危险因素。S100A4蛋白表达Logistic回归预测模型预测结膜黑色素瘤患者预后的敏感性、准确性、阳性预测值、曲线下面积分别为92.16%、90.02%、89.34%、0.914。结论肿瘤低分化、淋巴结转移、S100A4蛋白高表达是影响结膜黑色素瘤患者预后不良的危险因素,基于上述因素构建的模型预测结膜黑色素瘤患者预后不良的效能良好。

结膜下注射5-氟尿嘧啶在中青年复合式小梁切除手术中的应用

目的探讨在青光眼小梁切除术中结膜下注射5-氟尿嘧啶,对于易瘢痕化的中青年青光眼患者的远期治疗效果和眼表保护作用。方法研究2021年1月至2021年12月在常熟市第一人民医院行青光眼手术的患者39例(58只眼),分为结膜下注射组(18只眼),棉片组(20只眼)和对照组(20只眼)。其中对照组术中行小梁切除术+巩膜可调整缝线;结膜下组术中行小梁切除术+巩膜可调整缝线,同时术毕前结膜下注射5mg 5-氟尿嘧啶;棉片组行小梁切除术+巩膜可调整缝线,结膜瓣下方放置浸湿5-氟尿嘧啶棉片。术后进行共计6个月的随访,比较术后眼压、滤过情况、术后有效率情况和眼表疾病指数量表(ocular surface disease index,OSDI)评分情况。结果结膜下注射组和棉片组术后1个月、6个月眼压均较对照组低,且术后半年有效率高于对照组,安全性良好。同时,结膜下注射组术后OSDI评分显著低于棉片组和对照组。结论青光眼小梁切除术毕前结膜下注射5氟尿嘧啶,可以改善瘢痕化的中青年青光眼患者的手术效果、成功率和眼表症状且具有相当的安全性。

玻璃酸钠联合重组牛碱性成纤维细胞生长因子滴眼液治疗眼角结膜干燥症的临床疗效分析

目的探讨玻璃酸钠与重组牛碱性成纤维细胞生长因子滴眼液联合治疗眼角结膜干燥症的临床疗效。方法选取2020年7月至2022年1月建瓯市立医院收治的74例眼角结膜干燥症患者作为研究对象,采用随机抽样法分为观察组(玻璃酸钠联合重组牛碱性成纤维细胞生长因子滴眼液治疗)与对照组(单纯玻璃酸钠滴眼液治疗),每组37例。比较两组治疗前后眼功能指标、临床疗效及不良反应发生情况。结果用药2周后,两组国际标准眼表疾病指数(OSDI)均低于用药前,泪膜破裂时间(BUT)均长于用药前,且观察组OSDI值低于对照组,BUT长于对照组,差异有统计学意义(P<0.05);用药2周后,两组角膜荧光素染色评分(FL)、干眼症状评分(DESS)均低于用药前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论玻璃酸钠联合重组牛碱性成纤维细胞生长因子滴眼液治疗眼角结膜干燥症效果显著,能显著改善患者眼功能,延长泪膜破裂时间,且安全性较高,值得临床推广应用。

羊膜移植与自体结膜移植对翼状胬肉手术患者视觉质量角膜屈光及泪膜功能的效果观察

目的 本文对羊膜移植与自体结膜移植对翼状胬肉手术患者视觉质量角膜屈光及泪膜功能的效果展开简要分析与探讨。方法 将2020年10月—2022年10月在本院行翼状胬肉手术的100例患者作为研究对象,根据治疗方式不同分为2组,每组50例。其中,观察组采取羊膜移植治疗方式完成治疗,对照组采取自体结膜移植治疗,对比两组患者视觉质量角膜屈光及泪膜功能、治疗满意度及治疗后并发症发生率。结果 治疗前,两组患者视觉质量角膜屈光及泪膜破裂时间无明显差异(P>0.05);治疗后1个月,观察组患者角膜屈光度明显低于对照组,观察组患者泪膜破裂时间明显高于对照组,差异具有统计学意义(P<0.05)。观察组患者治疗总满意度明显大于对照组,差异具有统计学意义(P<0.05)。观察组患者治疗后并发症(感染、干眼症及散光)总发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论 羊膜移植手术治疗可大幅提升患者治疗满意度,降低患者治疗后并发症总发生率,提高患者视觉质量减少角膜屈光度,延长泪膜破裂时间。除此之外,还可保持美观,因此,羊膜移植可大大推广并应用于临床治疗。

Prevalence of HIV seropositivity among patients with squamous cell carcinoma of the conjunctiva

Objective:To determine the prevalence of HIV seropositivity among patients with squamous cell carcinoma of the conjunctiva.Methods:All patients with clinical and histopathological confirmation of squamous cell carcinoma seen during a ten year period(July 1999 to June 2009) were tested for HIV(Human Immunodeficiency Virus).The number of patients with squamous cell carcinoma of the conjunctiva who are HIV positive were counted.Results:A total of thirty-three(33) eyes in thirtytwo(32) patients were confirmed histopathologically to have conjunctival squamous cell carcinoma. Their ages ranged from 22 years to 66 yean with a mean age of(38.6± 11.8) years(SD).The male to female ratio was 1:1.5.Twenty four(75%) of these patients were HIV positive.Conclusions: Squamous cell carcinoma is associated with the human immunodeficiency virus and is thus a marker for the disease in Benin City,Nigeria.

Bare sclera resection followed by mitomycin C and/or autograft limbus conjunctiva in the surgery for pterygium:a Meta-analysis

AIM: To evaluate the recurrence and complications after bare sclera resection (BSR) combined with mitomycin C (MMC) treatment and/or autograft limbus conjunctiva (ALC) in the surgery for pterygium. METHODS: Meta -analysis was used to evaluate the differences in patient outcomes between BSR of pterygium with or without MMC and/or ALC. All included studies were randomized trials of patients with pterygium who received BSR followed by MMC and/or ALC in the surgery. The recurrence of pterygium and other complications resulting from different treatments were extracted for analysis. RESULTS: Thirteen studies met the inclusion criteria. The recurrence of pterygium with intraoperative (10) MMC was higher than that with ALC (OR=2.38,95% confidence interval 1.45-3.91, I-2=29%). Postoperative MMC resulted in an incidence of recurrence similar to that of ALC (OR= 0.66, 95% confidence interval 0.30-1.42, I-2=0%), and 10 MMC treatment in combination with ALC produced similar patient outcomes to ALC alone (OR =0.41, 95% confidence interval 0.16-1.01, I-2=16%). Other complications such as punctate epitheliopathy, scleral thinning and ischemia, irritation and persistent epithelium defect, were more common in patients in the MMC group as compared to those treated with ALC. CONCLUSION: The recurrence of pterygium with BSR followed by ALC is lower than that of BSR followed by MMC, and the incidence of other complications is lower. While ALC is a more effective strategy for treating pterygium, the quality of the ALC transplant should be considered when the patient has a history of glaucoma.

Conjunctival microbiome changes associated with fungal keratitis: metagenomic analysis

AIM: To investigate the ocular surface microbiome profile of patients with fungal keratitis(FK) through bacterial 16 S r DNA sequencing. METHODS: The swab samples were collected from 8 patients with FK(Group 1 from the corneal ulcer, Group 2 from the conjunctival sac of the infected eyes, and Group 3 from the conjunctival sac of the fellow eyes) and 10 healthy eyes(Group 4 from the conjunctival sac). Bacterial 16 S rDNA V4-V5 region sequencing was performed to characterize the bacterial communities on the ocular surfaces of the patients with FK. RESULTS: Our metagenomic data showed that 97% of the sequence reads were categorized into 245 distinct bacterial genera, with 67.75±7.79 genera detected in Group 1, 73.80±13.44 in Group 2, 74.57±14.14 in Group 3, and 89.60±27.49 in Group 4. Compared with the healthy eyes(Group 4), both infected(Groups 1 and 2) and fellow eyes(Group 3) of the patients with FK showed reduced bacterial diversity and altered ocular surface microbiota compositions, with lower abundance of Corynebacterium and Staphylo coccus and higher abundances of Pseudomonas, Achromobacter, Caulobacter and Psychrobacter. CONCLUSION: Our report depicts the altered ocular surface bacterial community structures both in the affected and fellow eyes of patients with FK. These changes may contribute to the pathogenesis of FK or the increased risk for FK.

Expressions of matrix metalloproteinases 1 and 3 and their tissue inhibitors in the conjunctival tissue and fibroblasts cultured from conjunctivochalasis

AIM：To investigate the expression of matrix metalloproteinases 1 and 3（MMP-1 and MMP-3） and their tissue inhibitors of metalloproteinases 1 and 3（ TIMP-1 and TIMP-3） in the conjunctiva of eyes with conjunctivochalasis（CCh）.METHODS：The conjunctival tissue was obtained from the CCh patients and controls,the MMPs/TIMPs expression concentration was determined by enzyme-linked immunosorbent assay（ELISA） and immunofluorescence staining.The expression levels of MMPs/TIMPs in the CCh fibroblasts were determined by analyzing its concentration in the cellular supernatant that was abstracted from the in vitro cultured CCh fibroblasts.RESULTS：MMP-1 and MMP-3 levels determined by ELISA were both significantly higher in the CCh group than that in the control group（P= 0.042,0.022,respectively）,so was the levels of TIMP-1（P= 0.010）.No significant difference in the expression of TIMP-3 in conjunctiva was found between the two groups（P= 0.298）.The expression of MMP-1 and MMP-3 were both up-regulated significantly in the CCh group（P= 0.040,0.001,respectively） on immunofluorescence staining.MMP-1 and MMP-3 expression in the fibroblasts were both significantly higher in the CCh group than that in the control group（P= 0.027,0.001,respectively）,while neither the TIMP-1 nor TIMP-3 expression was significantly different between the two groups（P= 0.421,0.237,respectively）.CONCLUSION：The overexpression of MMP-1 and MMP-3 in conjunctival tissue and fibroblasts may play an important role in the pathogenesis and development of CCh.

Comparison on conjunctival sac bacterial flora of the seniors with dry eye in Ganzi autonomous prefecture

AIM:To compare the bacterial flora in palpebral conjunctiva of xerophthalmia seniors of Tibetan,Yi and Han,and analyze the differences and similarities of the bacteria.·METHODS:The test subjects were selected from 2Tibetan,2 Yi and 3 Han populated places,respectively.Total 222 seniors(444 eyes) with dry eye were examined.Secretion was collected from the palpebral conjunctiva of the subjects and then inoculated onto a blood agar plate.After 48h of incubation,the bacteria were examined for the differences and similarities between different ethnics.·RESULTS:There was no significant difference(P 】0.05)of Gram stain characterization,dominant bacteria and number of the bacterial species present in oxrophthalmia patients among Tibetan,Yi and Han nationalities.The bacteria presented in all groups include staphylococcus epidermidis,corynebacterium,micrococcus luteu,int-racellular bacteria sphingomonas,pseudomonas aerug-inosa.The bacteria detected from the two of three ethnic groups were staphylococcus aureus,staphylococcus haemolyticus,escherichia coli,kytococcus sedentarius,streptococcus angina,micrococcus lylae,and staphy-lococcus heads.The incidence rate of bacteria-associated dry eye in Tibetan population was significantly lower than that of Han and Yi population.·CONCLUSION:There is no significant difference in the bacteria flora of palpebral conjunctiva observed among dry eye elder populations of Tibetan,Yi and Han people.All of staphylococcus epidermidis,corynebacterium,micrococcus luteu,intracellular bacteria sphingomonas,pseudomonas aeruginosa,staphylococcus aureus,staphylococcus haemolyticus,escherichia coli,kytococcus sedentarius,streptococcus angina,micrococcus lylae and staphylococcus heads are common bacteria flora of the three nationalities inhibiting in this area.

Evaluation of patients with dry eye disease for conjunctival Chlamydia trachomatis and Ureaplasma urealyticum

AIM：To determine the possibility of the development of dry eye disease（DED） as a result of persistent infection with Chlamydia trachomatis and Ureaplasma urealyticum in the conjunctiva of patients.METHODS： This study was conducted on 58 patients of age range 20-50 y,diagnosed with DED confirmed by Schirmer I test and tear breakup time.The non-dry eye control group included 27 subjects of the same age.Ocular specimens were collected as conjunctival scrapings and swabs divided into three groups： the first used for bacterial culture,the second and third taken to detect Chlamydia trachomatis and Ureaplasma urealyticum by direct fluorescent antibody（DFA） assay and polymerase chain reaction（PCR） method. RESULTS： Chlamydia trachomatis was detected in 65.5% and 76% of DED patients by DFA and PCR methods respectively.Ureaplasma urealyticum was found in 44.8% of DED infected patients using the PCR method.Both organisms were identified in only 37.9% of DED patients found to be infected.Control subjects had a 22%detection rate of Chlamydia trachomatis by DFA assay versus a 7% detection rate by PCR; while Ureaplasma urealyticum was detected in 3.7% of the controls by PCR method.The conjunctival culture revealed that gram positive microorganisms represented 75% of isolates with coagulase negative Staphylococci the most common（50%） followed by Staphylococcus aureus（20%）,whereas gram negative microorganisms occurred in 25% of cases,isolating Moraxella spp.as the most frequent organism. CONCLUSION： Our results tend to point out that Chlamydia trachomatis and Ureaplasma urealyticum were detected in a moderate percentage of patients with DED,and could be a fair possibility for its development.PCR is more reliable in detecting Chlamydia trachomatis than DFA technique.The presence of isolated conjunctival bacterial microflora can be of some potential value.

Conjunctival impression cytology in non-proliferative and proliferative diabetic retinopathy

AIMTo examine the integrity of the ocular surfaces of subjects with and without diabetes with no conjunctival and dry eye signs and symptoms and compare conjunctival impression cytology findings in diabetics with non-proliferative and proliferative diabetic retinopathy.

Incidence of orbital,conjunctival and lacrimal gland malignant tumors in USA from Surveillance,Epidemiology and End Results,1973-2009

AIM： To determine the types and incidence of tumors affecting the orbit, conjunctiva and lacrimal glands and to study the trend line of these tumors in the United States from 1973 to 2009.METHODS： We used the publicly available Surveillance, Epidemiology and End Results （SEER） database registries to determine the incidence rates. Age was adjusted to the 2000 US Standard Population. Patients were stratified according to age group, gender, race and histological grouping of tumor lesions. Three age groups were defined： 0-19, 20-49 and ≥50y. Annual percentage changes were calculated to examine trends.RESULTS： The overall age adjusted incidence rate was 3.39 （95%CI： 3.27-3.52） per million person-years. The tumors were more prevalent in age group ≥50 counting 9.51 （95%CI： 9.11-9.92） per million person-years. Most of the soft tissue sarcomas occurred in the young age with incidence rate of 0.35 （95%CI： 0.28-0.42） per million person-years. Lymphomas were the dominant subtype in the adult population with incidence rate of 5.74 （95%CI： 5.43-6.06） per million person-years. Incidence rates were higher in males than females with an overall rate ratio of 1.31 （95%CI： 1.21-1.41） mainly caused by the increase in carcinoma subtypes. White race had a higher tumor incidence with a rate ratio of 1.47（95%CI： 1.25-1.73） driven by the higher incidence of most histological subtypes. Orbital tumors showed a higher incidence rate followed by conjunctival and lacrimal gland tumors with incidence rates of 1.59, 1.37 and 0.43 per million person-years respectively. The trend line of overall incidence of tumors showed a significant increase （APC=3.11, 95%CI： 2.61-3.61） mainly due to increase of lymphomas. This increase was higher than the increase of lymphomas at other sites.CONCLUSION： Orbital, conjunctival and lacrimal gland malignant tumors differ among children and adults. Over the years there has been a noticeable increase in incidence rates of orbital and lacrimal gland tumors mainly caused by an increase in lymphomas and an apparent increase due to advances in diagnostic techniques. ICD-O-3 topographical coding should be improved to consider the different orbital bones and ocular structures.

Characteristics, management, and outcome of squamous carcinoma of the conjunctiva in a single tertiary cancer center in Jordan

AIM： To evaluate the features and outcome of management of malignant conjunctival squamous tumors in King Hussein Cancer Center（a referral tertiary cancer center in the Middle East）. METHODS： Retrospective case series of 31 eyes for 31 patients with conjunctival squamous neoplasia. Main outcome measures included： age, gender, laterality, tumor location, pathological features, tumor stage, treatment modality, and outcome. RESULTS： Twenty（65%） patients were males and median age was 58 y. Twenty-two（71%） eyes had the tumor in the nasal quadrant. Tumor invasion to nearby structures was seen in 19（61%） eyes, including the cornea, fornix, eyelid, and orbit in 17（55%）, 1（3%）, 2（6%）, and 3（10%） eyes, respectively. Eye salvage was achieved by surgical excision with cryotherapy followed by topical chemotherapy in 28（90%） eyes, and orbital exenteration was necessary in 3（10%） eyes due to orbital tumor invasion. Tumor recurrence was seen in 7（23%） eyes, and the significant predictive factors for recurrence were tumor extension onto the nearby structures（P=0.04）, tumor invasiveness（P=0.038）, and tumor TNM stage（P=0.031）. No significant change in visual acuity was seen, and disease related mortality was 6%（2 patients, both had orbital invasion by invasive squamous carcinoma）. CONCLUSION： Conjunctival squamous carcinoma is more common in males. Advanced American Joint Committee on Cancer（AJCC） T-stage, tumor local invasion, more pathologically aggressive tumors, and surgical treatment alone（without adjuvant therapy） are associated with higher risk for recurrence, and orbital invasion is the most important poor prognostic factor for metastasis and death. Treatment strategies should be affected by tumor characteristics at presentation.

Epidemiological, Clinical and Computed Tomographic Profile of Conjunctival Epidermoid Carcinoma: About 54 Cases

Conjunctival squamous cell carcinoma is a common malignant tumor in adults. It affects the peri-limbic conjunctiva. This is a neoplasia that is increasing in tropical Africa because it occurs in subjects with prolonged exposure to ultraviolet rays, in patients immunocompromised to the human immunodeficiency virus and HPV infection. Computed tomography allows one to make a diagnosis. We report the case of 57 patients in whom the diagnosis was made radiologically and confirmed by histology.

Bacterial flora of conjunctiva after death

AIM:To evaluate the frequency of bacterial flora of conjunctiva after death(cadaver eyes) which will give information about the bacterial contamination of donor eyes,and the in-vitro sensitivity of isolated bacteria to the commonly used antibiotics in ophthalmic practice.METHODS:Conjunctival swabs were taken from the cadavers(motor vehicle accident deaths and patients who died in the hospital),within 6h after death,and sent for culture and sensitivity test.Conjunctival swabs,taken from the healthy conjunctiva of patients admitted for cataract surgery,were sent for culture and sensitivity as controls(eyes in those of living status).The bacterial isolates were tested against the commonly used antibiotics(chloramphenicol,gentamicin,ciprofloxacin) in ophthalmology practice.RESULTS:Bacteria were isolated in 41 out of 100 conjunctival swabs(41%),taken from 50 cadavers(study group).Coagulase negative staphylococcus was the most common bacteria isolated(15%),followed by pseudomonas aeruginosa(5%).Gentamicin was effective against majority of the bacterial isolates(82%).Bacteria were isolated from 7 out of 100 conjunctival swabs taken as control group(eyes in living state).Coagulase negative staphylococcus was the most common organism(5%) isolated in control group;the others were staphylococcus aureus(1%) and beta hemolyticus streptococci(1%).CONCLUSION:Bacteria were isolated from 41% of the cadaver eyes.High percentage sensitivity of the bacterial isolates to gentamicin(82%) supports the practice of thorough irrigation of the eyes with gentamicin solution before starting the procedure of enucleation followed by immersion of the enucleated eyeballs in gentamycin solution,to prevent the bacterial contamination.

Surgical Treatment of the Semi-Lunar Fold Stromal Cysts in the Bulbar Conjunctiva in Polyclinic “SHOSHI” in Prishtina

Introduction: The conjunctiva is a thin, superficial mucosa that covers the anterior part of the eye lids and the anterior part of the sclera. The semi-lunar fold is located in the interior angle of the eye, and represents the third rudimentary eyelid. In the histological aspect, conjunctiva is composed of the epithelium and stroma. Thestroma is divided into two parts: the superficial adenoid part and the inner fibrotic part. The accessory lacrimal glands are found in the stroma. Materials and methods: A case study of a 14 year-old male patient, who came at our clinic as a result of a 5 - 6 mm tumefaction on the bulbar conjunctiva, on the nasal part of the bulbar conjunctiva, attached to the semi-lunar fold. The patient referred that the cyst appeared 6 - 7 months ago and was constantly growing. In the beginning the patient has been treated with antibiotic and corticosteroid eye drops. However, the cyst grew constantly therefore the best solution was the surgical treatment. The surgery was performed under local anesthesia. The total excision of the cyst was performed. The removed tumefaction was then diagnosed as a cyst of the conjunctival stroma. Purpose: The purpose of this study is to show that the best treatment of the conjunctival epithelium tumefaction, which is not reduced in size by the local treatment with antibiotics and corticosteroids, is the surgical treatment. Conclusion: Every change in the conjunctiva, causing functional and aesthetic problems, is an issue that should be directed to the ophthalmologist. Such changes should be treated with medications or surgically, the patient should be followed up, to see whether or not such changes will reappear.

Risk Factors for Conjunctival Microorganism Colonization in Adults Undergoing Intraocular Surgery

Purpose: To assess prevalence of and risk factors for conjunctival colonization and types of organisms among adults undergoing elective intraocular surgery. Setting: Ha’Emek Medical Center, Afula, Israel. Methods: A prospective study conducted in the Ophthalmology Department at Ha’Emek Medical Center, Afula, Israel between May 1, 2006 and August 31, 2007. Included were adults undergoing elective intraocular surgeries. Conjunctival cultures were obtained from the lower fornix, prior to application of prophylactic decolonization treatment and were processed using routine microbiological techniques. Demographic, socioeconomic and medical data of our patient cohort were obtained from all participants. Results: Cultures were obtained from 501 patients. (Mean age 69.7 ± 12.0 years) of whom 52.1% were females. In 208 patients (40.5%) bacteria grew in conjunctival cultures, one type in 175 (34.9%) one, and two types in 28 (5.6%). In none fungi were isolated. Coagulase negative Staphylococcus was the most frequent bacteria isolated. By multivariate analysis, significant risk factors for conjunctival bacterial colonization were spring/summer seasons (OR 1.64, CI 1.15 - 2.36, P < 0.007), and showering on the day of the operation (OR 1.73, CI 1.11 - 2.69, P < 0.01). Conclusions: In addition to previously known risk factors for conjunctival microorganism colonization, the present study found showering on the morning of the operation, possibly related to bacteria on towels or in the eyelids and lashes, and time of year (spring/summer) perhaps resulting from higher temperature and humidity related to the presence of conjunctival bacteria to be significant in adults undergoing intraocular surgery.