1/32. Conjunctival melanocytic nevi of childhood.Two young patients with conjunctival compound nevi are presented to illustrate two types of abnormalities that lead to difficulty in distinction of these nevi from invasive melanomas. In Case 1, inflammation is associated with disruption of the nevus cell architecture and cytologic atypia. In Case 2, the occurrence of a combined nevus (compound and blue nevus types) in the conjunctiva leads to diagnostic problems. Circumscription of the lesions, lack of mitoses in the substantia propria, and lack of pagetoid spread of atypical cells in the adjacent conjunctival epithelium support benign diagnoses in both cases.- - - - - - - - - - ranking = 1keywords = propria (Clic here for more details about this article) |
2/32. Malignant melanoma arising from unusual conjunctival blue nevus.Cellular blue nevus is an uncommon pigmented tumor in the conjunctiva, where it generally appears as a deep, circumscribed, pigmented conjunctival mass. We report a case of conjunctival blue nevus that clinically resembled primary acquired melanosis and gave rise to conjunctival melanoma. A 41-year-old man developed a diffuse pigmented mass in the inferior fornix of his left eye. Over a 20-year period, he noted slight progression of the pigment. Foci of epibulbar pigmentation were also present. The lesion resembled primary acquired melanosis. Excisional biopsy and adjuvant cryotherapy were performed. Histopathologic examination disclosed an intense infiltrate of heavily pigmented dendritic melanocytes with aggregates of less pigmented plump cells in the substantia propria. The conjunctival epithelium was normal. Malignant cellular features consistent with melanoma were observed in some foci. Cellular blue nevus of the conjunctiva can simulate primary acquired melanosis and can give rise to malignant melanoma. Arch Ophthalmol. 2000;118:1581-1584- - - - - - - - - - ranking = 1keywords = propria (Clic here for more details about this article) |
3/32. Amniotic membrane transplantation in the management of conjunctival malignant melanoma and primary acquired melanosis with atypia.AIM: To evaluate the efficacy of amniotic membrane transplantation (AMT) for the management of conjunctival malignant melanoma and primary acquired melanosis (PAM) with atypia. methods: Four consecutive patients with histologically proved invasive, primary conjunctival malignant melanoma were treated with wide surgical excision and AMT. Amniotic membrane grafts were harvested and processed under sterile conditions according to a standard protocol. The grafts were sutured to the margins of the surface defect. In one case, AMT was combined with a corneoscleral graft. RESULTS: A satisfactory result and rapid postoperative recovery with few, transient side effects was noted in three patients with limbal/epibulbar melanomas. In another patient with an extensive lesion, involving the epibulbar, forniceal, and palpebral conjunctiva, AMT following wide excision was complicated by symblepharon formation and restricted ocular motility. Monitoring of local recurrence was facilitated by the transparency of the thin graft in all cases. The postoperative follow up time varied between several months and 3 years. In one case, local recurrence of PAM was observed and treated using topical mitomycin. CONCLUSIONS: AMT is a useful technique for the reconstruction of both small and large surface defects that result from the surgical excision of conjunctival malignant melanoma and PAM. This method facilitates wide conjunctivectomy, although its role in repairing larger defects involving the fornix or palpebral conjunctiva still needs to be established. The transparency of amniotic membrane allows for monitoring of tumour recurrence, which is-together with superior cosmesis-an advantage over thicker (for example, buccal) mucous membrane grafts.- - - - - - - - - - ranking = 0.37600278293047keywords = membrane (Clic here for more details about this article) |
4/32. Management of conjunctival and corneal melanoma with surgical excision, amniotic membrane allograft, and topical chemotherapy.PURPOSE: To illustrate a novel method of management for extensive conjunctival and corneal melanoma. methods: Interventional case report. A 40-year-old Caucasian woman presented with a large, diffuse conjunctival melanoma involving 6 clock hours of the limbus. The remaining bulbar conjunctiva and the entire corneal epithelium were affected by diffuse, flat melanosis. RESULTS: The conjunctival melanoma was completely resected microsurgically in one piece without disrupting the tumor. The conjunctival melanosis was treated with double freeze-thaw cryotherapy. The extensive conjunctival defect, involving one-half of the bulbar conjunctiva, was reconstructed with an amniotic membrane allograft. The corneal melanosis was subsequently treated with topical mitomycin C eyedrops. At 8 months follow-up, the conjunctiva and the cornea were completely healed with resolution of all pigment and 20/20 visual acuity. CONCLUSION: Preliminary evidence suggests that combined therapeutic approaches, consisting of extensive tumor removal, cryotherapy, amniotic membrane allograft, and topical mitomyin C, can be effective in the management of diffuse conjunctival and corneal melanoma arising from primary acquired melanosis.- - - - - - - - - - ranking = 0.28200208719786keywords = membrane (Clic here for more details about this article) |
5/32. Amniotic membrane transplantation for reconstruction after excision of large ocular surface neoplasias.AIM: To evaluate the clinical outcome of patients in whom ocular surface reconstruction was performed using amniotic membrane transplantation (AMT) after the excision of large (>20 mm square) ocular surface neoplasias (OSN). methods: A non-comparative interventional case series. In 16 eyes of 16 patients, excision of large OSN including conjunctival intraepithelial neoplasia (CIN), primary acquired melanosis, and malignant melanoma was followed by adjunctive cryotherapy and suturing of a single layer of amniotic membrane (AM) with the basement membrane side facing up to the healthy bordering tissue. Epithelial healing, complications, and tumour recurrences were analysed. RESULTS: During a mean follow up of 23.7 (SD 11, range 11-43) months, ocular surface healing was rapid and complete in all cases. One complication of pyogenic granuloma was noted. Tumour recurrence occurred in one out of 10 CIN cases (10%), no recurrences were observed in the patients with melanotic lesions. CONCLUSIONS: AMT in lieu of conjunctival or mucosal autograft is an effective substrate for reconstructing the ocular surface following excision of large OSN. AMT is effective in managing large OSN by avoiding the complications that may be associated with conventional removal, specifically in cases where the limbal architecture is destroyed by surgical resection or adjuvant therapies.- - - - - - - - - - ranking = 0.32900243506416keywords = membrane (Clic here for more details about this article) |
6/32. Fornix and conjunctiva reconstruction by amniotic membrane in a patient with conjunctival mucosa-associated lymphoid tissue lymphoma.BACKGROUND: Conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma is a rare, low-grade, non-Hodgkin's B-cell lymphoma. Herein, we report our successful management of the large conjunctival defect caused by resection of conjunctival MALT lymphoma by covering it with transplanted amniotic membrane. CASE: A 28-year-old Japanese man, who had been diagnosed histologically as having conjunctival MALT lymphoma in his left eye, was referred to us for treatment. The tumor was located on the lower bulbar and palpebral conjunctiva, and involved the fornix. Extensive resection of the conjunctival lesion was performed. Two pieces of amniotic membrane were used to reconstruct the fornix, bulbar, and palpebral conjunctival defect. OBSERVATIONS: Epithelialization over the transplantation was completed within 3 weeks when all sutures were removed. During the 6 months of follow-up, there was no recurrence or any postoperative complication, such as graft rejection, symblepharon, or chronic inflammation. CONCLUSIONS: We demonstrated for the first time that amniotic membrane can be used to cover a large defect on both bulbar and palpebral conjunctiva when such a low-grade malignancy as MALT lymphoma is extensively excised. Amniotic membrane transplantation was quite effective for the fornix and conjunctival reconstruction.- - - - - - - - - - ranking = 0.37600278293047keywords = membrane (Clic here for more details about this article) |
7/32. Treatment of conjunctival squamous cell carcinoma with topical cidofovir.PURPOSE: To describe a case of conjunctival squamous cell carcinoma in situ that was successfully treated with adjunctive topical cidofovir. DESIGN: Interventional case report. methods: A 52-year-old woman presented with a diagnosis of diffuse conjunctival papillomatosis in the right eye. She underwent conjunctival biopsy followed by a 6-week course of cidofovir eyedrops (2.5 mg/ml). RESULTS: The biopsy specimen demonstrated squamous cell carcinoma in situ. After this biopsy and treatment with cidofovir, the mass regressed into a small vascular tuft, which was excised and treated with cryotherapy. Six months after cidofovir treatment, the patient developed cicatricial changes of the inferior punctum. No recurrence of the squamous cell carcinoma has occurred in 24 months of follow-up. CONCLUSION: Cidofovir has shown effectiveness in the treatment of neoplastic lesions involving various mucus membrane sites. This antiviral drug may be a valuable addition to our treatment armamentarium for patients with squamous cell carcinoma in situ of the conjunctiva. The possible relationship between topical cidofovir and cicatricial changes of the lacrimal system cannot be determined from this isolated report, but further investigation is indicated.- - - - - - - - - - ranking = 0.047000347866309keywords = membrane (Clic here for more details about this article) |
8/32. Amniotic membrane grafts following excision of corneal and conjunctival intraepithelial neoplasia.BACKGROUND: We evaluated the efficiency of amniotic membrane grafts (AMGs) for reconstructing the conjunctival surface following excision of corneal and conjunctival intraepithelial neoplasia (CIN). methods: This was a retrospective, noncomparative, interventional study. Five eyes in 5 patients were treated between April 1996 and September 2002 with the same procedure to apply amniotic membrane grafts after excising CIN. According to a standard protocol, the amniotic membrane was harvested and processed under sterile conditions. The amniotic membrane graft was applied over the excised bare scleral area and anchored with 10-0 nylon interrupted sutures. Patient data and clinical photographs were reviewed and analyzed. RESULTS: The mean follow-up period was 27 (range, 6-69) months. Ocular surface healing was rapid and complete in all cases. No recurrence was found. CONCLUSION: Amniotic membrane graft is an effective and safe alternative adjunctive treatment for primary CIN. Further studies with longer follow-up are recommended to evaluate the risk of recurrence and other adverse effects.- - - - - - - - - - ranking = 0.42300313079678keywords = membrane (Clic here for more details about this article) |
9/32. Malignant melanoma of conjunctiva--a case report.A 65-year-old male patient presented with a rapidly increasing mass in his left eye. It did not show any intra-ocular extension as examined by slit lamp, gonioscopy, indirect ophthalmoscopy and ultrasonography, nor there was any sign of systemic metastasis. The mass was excised completely. Buccal mucous membrane grafting was done to cover up the lower forniceal area and conjunctival autograft taken from right eye and placed over upper fornix and bulbar area. Postoperative radiotherapy was suggested. Histopathological examination of the mass revealed the diagnosis of malignant melanoma of conjunctiva.- - - - - - - - - - ranking = 0.047000347866309keywords = membrane (Clic here for more details about this article) |
10/32. Hughes technique, amniotic membrane allograft, and topical chemotherapy in conjunctival melanoma with eyelid involvement.A 59-year-old woman presented with a pigmented mass in the inferior tarsal conjunctiva of the left eye with an associated diffuse, multifocal pigmentation involving largely the inferior half of the bulbar conjunctiva, fornix, and eyelid skin. Histopathologic examination of map biopsies disclosed conjunctival melanoma from primary acquired melanosis. Surgical excision of the inferior bulbar conjunctiva, fornix, and lower eyelid with histopathologic free margins was performed. Adjuvant cryotherapy was applied. The bulbar conjunctiva and lower fornix were reconstructed with an amniotic membrane allograft. Lower eyelid reconstruction was accomplished by use of the Hughes technique. Topical mitomycin C (0.04%) was applied after surgery. After 2 years of follow-up, no tumor recurrence has been detected and the eyelid and conjunctival defect have been satisfactorily corrected. This combined surgical procedure using amniotic membrane allograft and a composite tarsoconjunctival flap is shown to be useful in the treatment of an advanced conjunctival neoplasia with extensive eyelid involvement.- - - - - - - - - - ranking = 0.28200208719786keywords = membrane (Clic here for more details about this article) |
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