[Selection and training in Canadian ophthalmology residency. A concept to be meditated?]

The authors describe in detail the modalities for the selection of students applying to the ophthalmology programs in the various Canadian universities; the university of Montréal will serve as a model. The characteristics of their 5-year training assured by numerous teachers and short training rotations as well as by a compulsory research project are explained. They highlight the meticulous organization and the compulsory constraints for students, teachers and universities. In absence of evaluation criteria on the efficiency of interventionist training compared to less detailed apprenticeship-program training such as that dispensed in France, they note the differences between the two systems, a necessary precursor to the standardization of training programs which would allow more complete recognition of degrees in the context of a globalization of professional activities.

Famciclovir for ophthalmic zoster: a randomised aciclovir controlled study

AIMS

To compare the efficacy and safety of famciclovir with aciclovir for the treatment of ophthalmic zoster.

METHODS

Randomised, double masked, aciclovir controlled, parallel group in 87 centres worldwide including 454 patients with ophthalmic zoster of trigeminal nerve (V(1)) comprised the intent to treat population. Oral famciclovir 500 mg three times daily or oral aciclovir 800 mg five times daily for 7 days. Assessments included day 0 (screening), days 3 and 7 (during treatment), days 10, 14, 21, 28 and monthly thereafter, up to 6 months (follow up). Proportion of patients who experienced ocular manifestations, severe manifestations and non-severe manifestations; loss of visual acuity was the main outcome measure.

RESULTS

The percentage of patients who experienced one or more ocular manifestations was similar for famciclovir (142/245, 58.0%) and aciclovir (114/196, 58.2%) recipients, with no significant difference between groups (OR 0.99; 95% CI 0.68, 1.45). The percentage of patients who experienced severe and non-severe manifestations was similar between groups, with no significant difference. The prevalence of individual ocular manifestations was comparable between groups. There was no significant difference between groups for visual acuity loss.

CONCLUSION

Famciclovir 500 mg three times daily was well tolerated and demonstrated efficacy similar to aciclovir 800 mg five times daily.

Malignant fibrous histiocytoma of the conjunctiva

We report the clinical and pathological findings in a case of malignant fibrous histiocytoma in the conjunctiva of a 60-year-old man. The patient initially had an atypical limbal lesion, resembling a pterygium, which was excised. Two local recurrences, noted during the following year, were treated by surgical excision followed by cryotherapy. Histopathologic examination of the conjunctival lesions showed a stromal neoplastic infiltrate composed of atypical spindle cells and histiocytelike cells. The immunohistochemical and ultrastructural studies suggested that the tumor was composed of various cellular elements: fibroblasts, myofibroblasts, and histiocytes.

Metastasis to the optic nerve: clinicopathological correlations

OBJECTIVE

To describe the clinical, radiologic and histopathological features of two cases of carcinoma metastatic to the optic nerve with different pathways of spread.

DESIGN

Chart review.

SETTING

Oncology clinic in Montreal.

PATIENTS

One patient previously treated for breast carcinoma and one patient previously treated for small-cell carcinoma of the lung.

RESULTS

The patient with breast carcinoma was found to have an elevated mass involving her right optic nerve head. This finding was confirmed by B-scan ultrasonography. The other patient initially presented with left retinal metastasis and subsequently manifested massive secondary involvement of the ipsilateral optic nerve, documented by computed tomography. Both patients were initially treated with radiotherapy to the eye and orbit, but postmortem histopathological study showed that this treatment had little effect on the tumour.

CONCLUSIONS

The histopathological observations suggest that if radiotherapy is to be used in the treatment of metastasis to the optic nerve, the dosage of radiation should be higher than that recommended for the treatment of choroidal metastasis.

DNA index and S phase fraction in uveal malignant melanomas

AIMS

To predict 5 year survival in patients with uveal malignant melanomas DNA indices were studied.

METHODS

Using 45 paraffin embedded uveal malignant melanomas, the DNA index and S phase fraction of each tumour were the predictor variables recorded.

RESULTS

Using the Cox proportional hazards model, aneuploid tumours and tumours which had an S phase fraction greater than 4% were significant predictors of early death. In order to demonstrate a biological gradient between a larger DNA index and shorter survival time, linear regression and transformed linear regression models were used. However, no such gradient could be demonstrated.

CONCLUSION

Although this study shows promise for the use of DNA studies in the prognosis of uveal malignant melanoma, the exact role of these techniques remains to be determined.

Orbital volume augmentation with adjustable prefabricated methylmethacrylate subperiosteal implants

Prefabricated right and left subperiosteal implants were used in nine anophthalmic sockets to correct superior sulcus deformities. The advantages of these implants include increased stability, easy insertion under direct visualization and the possibility of easy retrieval if necessary, and custom modification for volume and shape intraoperatively, with the addition of methylmethacrylate. There were no extrusions, implant migrations, or infections. Complications included mild undercorrection, upper eyelid blepharoptosis, and transient ectropion.

A clinicopathological study of seven globes enucleated after primary radiation therapy for malignant melanoma of the choroid or ciliary body

Seven patients with malignant melanoma of the choroid or ciliary body were initially managed with radiation therapy, either teletherapy with proton or cobalt 60 external beam, or brachytherapy with the insertion of an episcleral plaque containing iodine 125, 60Co or gold 198. All seven globes subsequently were enucleated because of progressive growth of the tumours, total retinal detachment, persistent vitreous hemorrhage, or neovascular or angle-closure glaucoma. Six of the patients had severe visual loss at the time of enucleation. The effects of radiation therapy on the neoplasms and the mechanisms for the visual loss are discussed.

Lymphoma simulating uveitis (masquerade syndrome)

The authors present three recent cases of intraocular lymphoma. All three patients presented with apparent hypopyon and uveitis. Although the diagnosis was a difficult one to make, an aspiration of the anterior chamber with appropriate cytologic studies was conclusive in one case. The neoplasm may masquerade as any type of intraocular inflammation, anterior or posterior. We discuss the management and prognosis of these patients and review 68 cases from the world literature. Radiation therapy plays an important palliative role in this condition.

Medical and psychosocial aspects of the habilitation of thalidomide children

The habilitation of 34 thalidomide children, begun in 1963 at the Rehabilitation Institute of Montreal, involved the contribution of many medical and paramedical disciplines. These individual contributions are described.Habilitation of congenitally deformed children must be initiated at an early age. The early prescription of a prosthesis is desirable. Their care involves a broad range of services that must be continued over many years. Parents require support before they can accept the misfortune that has befallen them and their deformed child. Despite the necessity of frequent hospitalizations, children should be reared in a home setting. From their experience, the authors conclude that children born with malformations, and their parents, should be thoroughly evaluated and followed up for many years; and recommend that governments should finance programs for the complete habilitation of all children born with congenital malformations. National registries for the compulsory recording of birth deformities should also be established.