Safety and efficacy of posterior sub-Tenon＇s carboplatin injection versus intravitreal melphalan therapy in the management of retinoblastoma with secondary vitreous seeds

AIM： To evaluate the safety and efficacy of posterior sub-Tenon＇s carboplatin injection compared to intravitreal melphalan injection in the management of retinoblastoma （RB） with secondary vitreous seeds. The outcome measures were vitreous seeds regression, need for other treatment modalities to achieve ocular salvage and treatment side effects. METHODS： A prospective interventional comparative nonrandomized study included RB eyes developed secondary vitreous seeds during the period of follow up. They subdivided into two groups： study group Ⅰ where posterior sub-Tenon＇s carboplatin （20 mg/2 mL） was injected and study group Ⅱ where intravitreal melphalan （20 μg/0.1 mL） was injected. The injections repeated every 2-4wk. RESULTS： Thirty-three eyes were included in the study. Seventeen eyes （16 patients） in study group Ⅰ and 16 eyes （16 patients） in study group Ⅱ. Ten eyes （30.3%） were completely salvaged following local chemotherapies, Ocular salvage was 23.5% following posterior sub-Tenon＇s carboplatin injection versus 37.5% following intravitreal melphalan raised to 47.1% and 75% with addition of external beam radiotherapy （EBR） with no statistically significant difference between the study groups （P=0.16）. A statistically significant correlation was found between ocular salvage rate and type of vitreous seeds either dust, spheres and clouds （r=0.42, P=-0.015） and eyes harbor new solid tumor growth （r=0.35, P=0.045）. The mean and median follow up periods following local chemotherapy injections were 2.0y in the study group Ⅰand 2.37y in the study group Ⅱ. Few complications were reported： periorbital edema in all eyes and ocular motility disturbances in 13 eyes （76.5%） following posterior sub-Tenon＇s carboplatin injection. Vitreous hemorrhage developed in 2 eyes （12.5%） and localized retinopathy in 5 eyes （31.25%） following intravitreal melphalan. ~ CONCLUSION： Local chemotherapy for treatment of RB with secondary vitreous seeds is safe and can salvage 30.3% of eyes without EBR. There is a superiority of intravitreal melphalan in ocular salvage however, no statistically significant difference between both groups.

Visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery

AIM:To investigate the visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery.METHODS:In this prospective case series, consecutive patients who underwent combined phacoemulsification and pars plana vitrectomy(PPV) under sub-Tenon anesthesia between October 2008 and September 2009 were enrolled. The patients were asked whether they could see the light of the operating microscope or not between various surgical steps with their contralateral eye being covered.RESULTS:A total of 163 eyes of 163 patients were enrolled in this study. After their contralateral eyes were covered, 152(93.3%) patients said that they could not see any light at least during one of the surgical steps. All eyes recovered to at least light perception on the first postoperative day. The incidence of no light perception during the surgery was not related to demographic factors, including age, gender, or type of ocular diseases.CONCLUSION:The incidence of no light perception during combined phacoemulsification and vitrectomy under sub-Tenon anesthesia was high in our study.Patients should be duly informed about this temporary but potential intraoperative event.

New onset atrial fibrillation following sub-Tenon's anaesthesia

Dear Sir,We write to report a case of new onset atrial fibrillation following sub-Tenon’s block.Cataract surgery is nowadays mostly performed as a day case procedure with 95.5%of surgery performed under local anaesthesia.This can be done with sub-Tenon’s,retrobulbar,peribulbar,intracameral or topical anaesthesia[1].Sub-Tenon’s anaesthesia involves opening the conjunctiva and tenon’s

Necrotizing Scleritis Associated with 5-Fluorouracil and Sub-Tenon’s Block in Patient with Previous Trabeculectomy: A Case Report

Necrotizing scleritis is the most severe form of scleritis with a significant threat to vision and globe integrity. It can be infectious, surgically induced necrotizing scleritis (SINS) or systemic autoimmune associated. We report a case of necrotizing scleritis associated with 5-fluorouracil (5-FU) at the site of sub tenon’s block in a patient with previous trabeculectomy. To our knowledge, this is the first reported case of necrotizing scleritis associated with 5-FU. This may implicate alternative approaches to local anaesthetic techniques when using adjunctive 5-FU.

Comment on visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery

Dear Editor,We read with interest the article by Chen etaitlj on the visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery. The authors reported that 93.3% of patients in the study experienced loss of perception of light at least during one of the surgical steps after the contralateral eye was covered intraoperatively. Most of the patients （81%） reported losing light perception between 6min and 30min from the commencement of the surgery.