Purpose To report a series of 15 primary lacrimal sac tumours and present an algorithm in managing this rare condition. Design Noncomparative interventional case series. Methods A retrospective review of the clinical, radiological, and pathological records of 15 patients with primary lacrimal sac tumours. Main outcome measures Histologic evaluation and clinical follow-up, including tumour clearance and recurrence, were assessed. Results Of the patients, 11 were female and the median age at presentation for the whole group was 59 years (range 22-94 years). The commonest tumour was non-Hodgkins B-cell lymphoma (five cases), followed by two cases each of squamous cell carcinoma and transitional cell carcinoma, one case of benign transitional papilloma, haemangiopericytoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, mixed (squamous/transitional) carcinoma, and a highly malignant undifferentiated tumour. Treatment modalities included surgery, radiotherapy and chemotherapy and, with a median follow-up of 30 months (range 2 months to 17 years), two patients had died from metastatic disease but nine patients remained without evidence of recurrent tumour. Conclusions Primary lacrimal sac tumours are extremely rare, require long-term followup for recurrence and metastasis, and can be fatal.
AimsTo determine the accuracy of diagnosing microbial keratitis by masked medical and non-medical observers using the Heidelberg Retina Tomograph II / Rostock Cornea Module in vivo confocal microscope.
MethodsConfocal images were selected for 62 eyes with culture or biopsy proven infections.
ResultsThe highest sensitivity and specificity values were 55.8% and 84.2%, and the lowest sensitivity and specificity values were 27.9% and 42.1%. The highest positive and negative likelihood ratios were 2.94 and 0.59, respectively. Agreement values were:fair to moderate (κ, 0.22-0.44) for reference standard versus observer diagnosis, moderate to good in intra-observer variability (repeatability, κ 0.56-0.88), and poor to moderate in inter-observer variability (reproducibility, κ , 0.15-0.47). The correct 4 diagnosis was associated with duration of disease for Acanthamoeba keratitis (r s = 0.60, p = 0.001).
Conclusions
This paper aims to review the recent literature describing Acanthamoeba keratitis and outline current thoughts on pathogenesis, diagnosis, and treatment as well as currently emerging diagnostic and treatment modalities.
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