PURPOSE. We examined the clinical differences in manifestation and prognosis of uveal melanoma (UM) between men and women.METHODS. We evaluated 723 UM patients (325 males) who were treated between 1988 and 2010 at a national referral center. Men and women were compared regarding differences in annual distribution, age at diagnosis, size and intraocular location of the tumor, symptoms leading to diagnosis, recurrence, development of metastases, and mortality. Statistical analysis included ANOVA, Pearson correlations, and competing risks for melanoma-related mortality.RESULTS. Significant gender differences were not found for annual distribution, diagnosis age, tumor size, or recurrence rate. Tumors were located more frequently posterior to the equator in men than in women. However, men were less likely than women to complain of symptoms before the diagnosis (77.10% vs. 84.65%). Men suffered more metastases. In the subgroup of patients who had metastases, the time until development of metastases was shorter in men (metastases 1 and 5 years after diagnosis of UM: 26% vs. 12.96% and 84% vs. 50%, respectively). The cumulative incidence for melanomarelated mortality was higher for men, with an almost two-fold excess of male melanoma-related mortality in the first 10 years after the diagnosis of UM. CONCLUSIONS.Men have earlier and more frequent metastases in the first decade after the diagnosis of UM, a fact that may have significant implications in planning clinical trials to test adjuvant therapies to prevent metastasis. (Invest Ophthalmol Vis Sci. 2013;54:652-656) DOI:10.1167/iovs.12-10365 U veal melanoma (UM) is the most common primary intraocular malignancy in adults. A thorough study based on the American Surveillance, Epidemiology and End Results (SEER) cancer registry, showed that the mean age-adjusted incidence of UM in the United States was 5.1 per million, with significantly more men affected (men 5.8, women 4.4). 1 In a previous study Singh et al. presented a summary of studies from all over the world that showed variation in incidence rates among different countries, although generally the incidence rate in women was lower than in men. 2 The underlying causes of UM are still unknown despite extensive research into the etiology of the disease during the last decades. The disease seems to be multifactorial. Race 3 and genetic predisposition 4 have been suggested as possible risk factors.The tumor is usually diagnosed due to complaints of disturbances in visual fields, blurred vision, and sometimes due to an episcleral pigmented lesion. However, the tumor can occasionally be found on a routine eye examination. The age at diagnosis, intraocular localization of the tumor, size of the tumor, and existence of metastasis are important clinical prognostic factors of the disease, and can be augmented by histopathologic, cytogenetic, and molecular characteristics. 5,6 According to the Collaborative Ocular Melanoma Study (COMS), even if the treatment was considered a success, 5-and 10-year cumulative metastasis rates...

Susac syndrome is a rare condition characterized by the clinical triad of central nervous system (CNS) dysfunction, sensorineural hearing impairment, and branch retinal artery occlusion (BRAO). The purpose of this study is to examine the demographics, clinical characteristics, treatment, and long-term prognosis of Susac syndrome. The data recorded for all Susac syndrome patients treated at the Sheba Medical Center between 1998 and 2014 included demographics, clinical signs at presentation and during the disease course, imaging findings, treatment, and prognosis.Susac syndrome was diagnosed in 10 patients (age range 30–45 years). Only 2 patients presented with the full triad and 7 patients developed the full triad during mean follow-up period of 35 months. The average time to full triad was 7 months. Based on our observations at presentation, we divided the disease course into suspected, incomplete, and complete Susac syndrome. All 10 patients were treated at diagnosis with a pulse of high-dose intravenous methylprednisolone. There was improvement in visual acuity and visual field at the end of follow-up compared to baseline, but it was not statistically significant (P = 0.479 and P = 0.053, respectively). Five patients remained with neurological damage, and 5 patients had no improvement of their hearing loss at study closure. In conclusion, Susac syndrome is a rare condition that can mimic other disorders. The diagnosis is challenging because most patients do not initially present with the definitive triad. We suggest a clinical classification for the syndrome that may assist in early diagnosis.

No abstract

Most pediatric ophthalmologists treat to decrease myopia. They employ a wide variety of means to decrease myopia progression. Atropine 0.01% is the most popular and safe modality used similarly to recent reports. However, there is no consensus when treatment should be initiated. Further prospective studies are needed to elucidate the best timing to start treatment and the applicability of recent studies in the Asian population to other ethnic groups. This will improve the ability to update pediatric ophthalmologist with evidenced-based treatment options to counter the myopia epidemic.