Autologous fat grafting has been extensively and successfully adopted in a number of pathologic conditions in regenerative surgery especially on irradiated fields in order to improve pain symptoms and tissue trophism promoting scar release. In the present study, we report our experience with autologous fat grafting for the treatment of postirradiation fibrosis and pain on three consecutive patients undergoing orbital enucleation for locally advanced retinoblastoma (RB) and subsequent radiotherapy. We selected three consecutive patients who underwent orbital enucleation for locally advanced RB and subsequent local radiotherapy showing severe reduction in orbital volume and eyelid length and retraction due to fibrosis, spontaneous local pain exacerbated after digital pressure with no possibility to place an ocular implant. They underwent autologous fat grafting in the orbital cavity and results were evaluated by clinical examination at 5 and 14 days, and 1, 3, 6 months, and 1 year after surgery. A significant release of scar retraction, reduction of fibrosis and orbital rim contraction together with an important improvement of pain symptoms was observed in all patients. The local changes observed enabled an ease placement of an ocular prosthetic implant (implant). No local or systemic complication occurred. Fat grafting is a promising treatment for patients showing radiotherapy related complication in the orbital area and it should be adopted by all oculoplastic surgeon in order to improve pain syndrome creating the ideal local conditions for the placement of an ocular prosthetic implant.

Purpose: Spreading from China, COVID-19 pandemic reached Italy, the first massively involved western nation. At the beginning of March, 2020 in Northern Italy a complete lockdown of activities was imposed. Access to all healthcare providers, was halted for patients with elective problems. We present the management experience of the Humanitas Clinical and Research Center Ophthalmology Department in Rozzano, Milan, Italy, during the lockdown. Methods: Containment measures were taken to reduce viral transmission and identify infected patients. All planned visits were canceled but for those not deferrable. Social distancing was introduced reducing number of visits per hour. Minor surgery for progressive pathologies was continued. As the lockdown prolonged, we reorganized patient care. All canceled cases were evaluated by electronic medical records analysis and telephonic triage, to identify, recall, and visit patients at risk of vision loss. Results: From March 9, to April 30, 2020 we performed a total of 930 visits and 612 exams. Some visits ( n = 698) and exams ( n = 160) were deemed as necessary for continuity of care and performed as planned. Among the remaining 1283 canceled appointments, after evaluation 144 visits and 32 instrumental exams were classified as urgent and rapidly rescheduled. Performed surgical activities were limited to corneal collagen cross linking ( n = 39) and intravitreal injections ( n = 91), compared to 34 and 94, respectively, in the same period of 2019. Conclusion: In-office activities deemed not deferrable were performed safely. The recall service was highly appreciated by all patients. No patient or staff member reported symptoms of COVID-19.

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An interventional pilot study to assess the tolerability and activity of the intralesional injection of rituximab, a chimeric mAb that targets the CD20 antigen, in patients with orbital B-cell lymphoma. Five patients received four intralesional injections (one injection a week) of rituximab together with ropivicaine 2%. Side-effects and tumor response were assessed after each injection and during the follow-up (20 months). Two patients obtained complete remission of the intraorbital lesion. Two patients showed incomplete response after induction therapy and received planned escalating rituximab doses, obtaining regression of subjective symptoms. One patient did not achieve tumor regression after the first injection and underwent systemic treatment. This small exploratory study suggests that intralesional rituximab is a well-tolerated treatment for patients with primary ocular adnexal lymphoma. These preliminary findings suggest that intralesional rituximab is a well-tolerated strategy in anterior intraorbital lesion localization of lymphoma. (Cancer Sci 2011; 102: 1565-1567 S everal studies suggest that extranodal marginal zone lymphoma (1,2) of mucosa-associated lymphoid tissue (MALT) is the most common type of primary ocular adnexal lymphoma (OAL). Mucosa-associated lymphoid tissue lymphoma is an indolent B-cell non-Hodgkin's lymphoma (NHL) characterized by mitotic division of the marginal zone cells within the reactive follicles.(3) It is most commonly seen in the elderly, most frequently affects the stomach, and normally follows an indolent course. It usually arises at sites of chronic inflammation secondary to persistent infections or autoimmune disorders.(4) Ocular MALT lymphoma has been shown to be related to the Chlamydia psittaci infection (5) but results from several studies are conflicting. (3,6) The accepted criteria for the diagnosis of MALT are strong staining for CD20, with CD10, CD23, and BCL6 negativity. In order to assess the disease and to define the optimal treatment the following criteria should be considered: (i) histopathological subtype; (ii) extent of the disease (in the ocular region and systemically); and (iii) impact of the lymphoma on the eye and visual function. Thus, the treatment decision varies from patient to patient and uniform guidelines for the treatment of ophthalmic lymphoma have yet to be established.It is now well accepted that localized proliferation of primary OAL can be controlled using radiotherapy. (7,8) Chemotherapy alone or in combination with radiotherapy is considered to be standard therapy for patients with extraorbital involvement. (9) However, there are significant adverse effects of the current treatment strategy.Recent evidence shows that systemic treatment using the monoclonal anti-CD20 antibody rituximab seems to be an effective, safe alternative for localized CD20 + OAL and for intraocular diffuse large B-cell lymphoma.(10) However, systemic treatment with rituximab is expensive and not without sideeffects. Intralesional injection of rituximab has also be...