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Nonsurgical Therapy of Chalazion
424
AMERICAN JOURNAL OF OPHTHALMOLOGY
2. Cooperman, E., and Friedman, A.: Exogenous Moraxella liquefaciens endophthalmitis. Ophthalmologica 171:177, 1975. 3. Breslin, A., Biggs, J., and Hall, G.: Bacterial endocarditis due to Neisseria perjlava in a patient hypersensitive to penicillin. Aust. Ann. Med. 16:245, 1965.
Nonsurgical Therapy of Chalazion Editor: In 1978 Pizzarello and his colleagues' conducted a trial of intralesional injections of triamcinolone acetonide in 17 chalazia of 12 patients and reported good results over a follow-up period of two months. We undertook a similar study to evaluate the efficacy of intralesional corticosteroids in the management of various clinical types of chalazia and to assess the local complications, if any, occurring over a long period of time after injection. In 60 patients 90 chalazia were treated with intralesional injections of 0.05 ml to 0.3 ml of a 5-mglml suspension of triamcinolone acetonide (Kenacort). In patients with many chalazia, all the swellings were injected in the same sitting. No pad or bandage was used. The patients were followed up at regular intervals for periods ranging from six to 22 months. If the swelling had not reduced to half its
SEPTEMBER, 1982
original size in seven days a second injection was given and if it still did not show any signs of regression it was managed surgically. In 12 patients 15 chalazia were injected with an equal volume of normal saline and another 15 chalazia in 11 patients were injected with an equal volume of a 4-mg/ml solution of dexamethasone. These served as controls. Of the 90 chalazia 84 resolved within 15 days of injection and only 11 of these required a second injection, giving an overall efficacy of 93.33%. The chalazia that did not respond were like hard lead pellets in consistency and were present for over six months. Yellow deposits, tissue atrophy, hypopigmentation, or increased intraocular pressure were not noted in any case. All the control patients failed to respond and were managed surgically. We concluded that intralesional triamcinolone acetonide is effective in resolving acute and subacute chalazia of soft to firm consistency irrespective of their size. Hard chalazia of long duration are not suitable for this form of therapy because considerable fibrosis and hyalinization have already occurred. The advantages of this method over conventional surgery are as follows: the
Figure (Dua and Nilawar). Left, A large chalazion situated at the medial end of the left lower eyelid over the lower lacrimal canaliculus. Right, The same patient seven days after injection of triamcinolone acetonide shows complete resolution.
VOL. 94, NO. 3
CORRESPONDENCE
time required is usually less than five minutes, patching or bandaging of the eye is not necessary and therefore multiple chalazia in eyelids of both sides can be managed in the same sitting. Bleeding and pain are minimal. The patients must come to the hospital only once and rarely a second time. The risk of damage to the lacrimal canaliculi and posterior border of the eyelid margins by surgery on chalazia situated near the medial canthus (Figure) or eyelid margins is totally eliminated by this method. It has a high patient acceptance and reduces the cost of therapy considerably. HARMINDER SINGH DUA, M.S. DEEPAK. V. NILAWAR, M.S.
Nagpur, India REFERENCE 1. Pizzarello, L. D., jakobiec, F. A., Hofeldt, A. J., Podolsky, M. M., and Silvers, D. N.: Intralesional corticosteroid therapy of chalazia. Am. J. Ophthalmol. 85:818, 1978.
Retinoids and Intraocular Tumors Editor: Vitamin A and related analogs are effective in the prevention and treatment of chemically induced carcinogenesis in certain experimental animal models;' Although success has been limited primarily to chemically induced carcinogenesis, one study demonstrated the inhibitory effect of retinol palmitate on the subcutaneous growth of the S91 Cloudman melanoma in Balb/C mice.f Retinoblastoma of the Y79 cell line is known to have soluble receptors for retinol and retinoic acid." Retinoids are cytotoxic in tissue culture to these cells." These observations prompted us to evaluate the in vivo efficacy of retinoids in the inhibition of ocular melanoma and retinoblastoma in animal models: We used "nude" mice (animals with a deficit in cellular immunity) to test the
425
inhibitory potential of vitamin A on retinoblastoma. Details of this model have been published previously." Three retinoids (retinol, 13-cis retinoic acid, and retinol palmitate) were tested with total doses of 0.1 mg, 1 mg, and 75 mg per animal respectively. These were given intraperitoneally in ten divided doses at 48-hour intervals. Retinoblastoma cells were transferred to the nude mice on the day of the fifth injection." There was no significant difference between the rate of tumor induction in the experimental and control animals treated with retinol (nine of 16 vs six of 12 eyes), 13-cis retinoic acid (ten of 20 vs 12 of 20 eyes), or retinol palmitate (22 of 38 vs 28 of 44 eyes). Two models were used to test the efficacy of vitamin A inhibition of the transplantation of intraocular melanomas. In the first, Syrian hamsters received 200,000 units of retinol palmitate, divided into ten doses and injected intraperitoneally at 48-hour intervals. Five injections were given before tumor challenge with 1 X 105 Green hamster melanoma cells injected into the posterior segment of the eye. There was no significant difference in the rate of tumor induction between the experimental (nine of 16 eyes) and control (six of 12 eyes) animals. Next, approximately 1 X 105 Cloudman melanoma cells were injected into the posterior segment of Balb/C mice and were given subcutaneously after a total dose of 50,000 units of retinol palmitate administered as described. There was an identical rate of tumor induction (28 of92 eyes) in the experimental and control groups. Additionally, we did not demonstrate a significant inhibition of subcutaneous growth of melanoma (29 of 100 tumor takes in the experimental group vs 24 of 110 tumor takes in the control group). In the nude mouse, the difference between in vivo and in vitro efficacy of
AMERICAN JOURNAL OF OPHTHALMOLOGY
2. Cooperman, E., and Friedman, A.: Exogenous Moraxella liquefaciens endophthalmitis. Ophthalmologica 171:177, 1975. 3. Breslin, A., Biggs, J., and Hall, G.: Bacterial endocarditis due to Neisseria perjlava in a patient hypersensitive to penicillin. Aust. Ann. Med. 16:245, 1965.
Nonsurgical Therapy of Chalazion Editor: In 1978 Pizzarello and his colleagues' conducted a trial of intralesional injections of triamcinolone acetonide in 17 chalazia of 12 patients and reported good results over a follow-up period of two months. We undertook a similar study to evaluate the efficacy of intralesional corticosteroids in the management of various clinical types of chalazia and to assess the local complications, if any, occurring over a long period of time after injection. In 60 patients 90 chalazia were treated with intralesional injections of 0.05 ml to 0.3 ml of a 5-mglml suspension of triamcinolone acetonide (Kenacort). In patients with many chalazia, all the swellings were injected in the same sitting. No pad or bandage was used. The patients were followed up at regular intervals for periods ranging from six to 22 months. If the swelling had not reduced to half its
SEPTEMBER, 1982
original size in seven days a second injection was given and if it still did not show any signs of regression it was managed surgically. In 12 patients 15 chalazia were injected with an equal volume of normal saline and another 15 chalazia in 11 patients were injected with an equal volume of a 4-mg/ml solution of dexamethasone. These served as controls. Of the 90 chalazia 84 resolved within 15 days of injection and only 11 of these required a second injection, giving an overall efficacy of 93.33%. The chalazia that did not respond were like hard lead pellets in consistency and were present for over six months. Yellow deposits, tissue atrophy, hypopigmentation, or increased intraocular pressure were not noted in any case. All the control patients failed to respond and were managed surgically. We concluded that intralesional triamcinolone acetonide is effective in resolving acute and subacute chalazia of soft to firm consistency irrespective of their size. Hard chalazia of long duration are not suitable for this form of therapy because considerable fibrosis and hyalinization have already occurred. The advantages of this method over conventional surgery are as follows: the
Figure (Dua and Nilawar). Left, A large chalazion situated at the medial end of the left lower eyelid over the lower lacrimal canaliculus. Right, The same patient seven days after injection of triamcinolone acetonide shows complete resolution.
VOL. 94, NO. 3
CORRESPONDENCE
time required is usually less than five minutes, patching or bandaging of the eye is not necessary and therefore multiple chalazia in eyelids of both sides can be managed in the same sitting. Bleeding and pain are minimal. The patients must come to the hospital only once and rarely a second time. The risk of damage to the lacrimal canaliculi and posterior border of the eyelid margins by surgery on chalazia situated near the medial canthus (Figure) or eyelid margins is totally eliminated by this method. It has a high patient acceptance and reduces the cost of therapy considerably. HARMINDER SINGH DUA, M.S. DEEPAK. V. NILAWAR, M.S.
Nagpur, India REFERENCE 1. Pizzarello, L. D., jakobiec, F. A., Hofeldt, A. J., Podolsky, M. M., and Silvers, D. N.: Intralesional corticosteroid therapy of chalazia. Am. J. Ophthalmol. 85:818, 1978.
Retinoids and Intraocular Tumors Editor: Vitamin A and related analogs are effective in the prevention and treatment of chemically induced carcinogenesis in certain experimental animal models;' Although success has been limited primarily to chemically induced carcinogenesis, one study demonstrated the inhibitory effect of retinol palmitate on the subcutaneous growth of the S91 Cloudman melanoma in Balb/C mice.f Retinoblastoma of the Y79 cell line is known to have soluble receptors for retinol and retinoic acid." Retinoids are cytotoxic in tissue culture to these cells." These observations prompted us to evaluate the in vivo efficacy of retinoids in the inhibition of ocular melanoma and retinoblastoma in animal models: We used "nude" mice (animals with a deficit in cellular immunity) to test the
425
inhibitory potential of vitamin A on retinoblastoma. Details of this model have been published previously." Three retinoids (retinol, 13-cis retinoic acid, and retinol palmitate) were tested with total doses of 0.1 mg, 1 mg, and 75 mg per animal respectively. These were given intraperitoneally in ten divided doses at 48-hour intervals. Retinoblastoma cells were transferred to the nude mice on the day of the fifth injection." There was no significant difference between the rate of tumor induction in the experimental and control animals treated with retinol (nine of 16 vs six of 12 eyes), 13-cis retinoic acid (ten of 20 vs 12 of 20 eyes), or retinol palmitate (22 of 38 vs 28 of 44 eyes). Two models were used to test the efficacy of vitamin A inhibition of the transplantation of intraocular melanomas. In the first, Syrian hamsters received 200,000 units of retinol palmitate, divided into ten doses and injected intraperitoneally at 48-hour intervals. Five injections were given before tumor challenge with 1 X 105 Green hamster melanoma cells injected into the posterior segment of the eye. There was no significant difference in the rate of tumor induction between the experimental (nine of 16 eyes) and control (six of 12 eyes) animals. Next, approximately 1 X 105 Cloudman melanoma cells were injected into the posterior segment of Balb/C mice and were given subcutaneously after a total dose of 50,000 units of retinol palmitate administered as described. There was an identical rate of tumor induction (28 of92 eyes) in the experimental and control groups. Additionally, we did not demonstrate a significant inhibition of subcutaneous growth of melanoma (29 of 100 tumor takes in the experimental group vs 24 of 110 tumor takes in the control group). In the nude mouse, the difference between in vivo and in vitro efficacy of