424 AMERICAN JOURNAL OF OPHTHALMOLOGY SEPTEMBER, 1982

2. Cooperman, E., and Friedman, A.: ExogenousMoraxella liquefaciens endophthalmitis. Ophthalmo­logica 171:177, 1975.

3. Breslin, A., Biggs, J., and Hall, G.: Bacterialendocarditis due to Neisseria perjlava in a patienthypersensitive 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 17chalazia of 12 patients and reported goodresults over a follow-up period of twomonths.

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 localcomplications, if any, occurring over along period of time after injection.

In 60 patients 90 chalazia were treatedwith intralesional injections of 0.05 ml to0.3 ml of a 5-mglml suspension of triam­cinolone acetonide (Kenacort). In pa­tients with many chalazia, all the swell­ings were injected in the same sitting. Nopad or bandage was used. The patientswere followed up at regular intervals forperiods ranging from six to 22 months. Ifthe swelling had not reduced to half its

original size in seven days a second injec­tion was given and if it still did not showany signs of regression it was managedsurgically.

In 12 patients 15 chalazia were injectedwith an equal volume of normal salineand another 15 chalazia in 11 patientswere injected with an equal volume of a4-mg/ml solution of dexamethasone.These served as controls.

Of the 90 chalazia 84 resolved within 15days of injection and only 11 of theserequired a second injection, giving anoverall efficacy of 93.33%. The chalaziathat did not respond were like hard leadpellets in consistency and were presentfor over six months. Yellow deposits, tis­sue atrophy, hypopigmentation, or in­creased intraocular pressure were notnoted in any case. All the control patientsfailed to respond and were managed sur­gically.

We concluded that intralesional triam­cinolone acetonide is effective in resolv­ing acute and subacute chalazia of soft tofirm consistency irrespective of theirsize. Hard chalazia of long duration arenot suitable for this form of therapy be­cause considerable fibrosis and hyaliniza­tion have already occurred.

The advantages of this method overconventional surgery are as follows: the

Figure (Dua and Nilawar). Left, A large chalazion situated at the medial end of the left lower eyelid overthe lower lacrimal canaliculus. Right, The same patient seven days after injection of triamcinolone acetonideshows complete resolution.

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time required is usually less than fiveminutes, patching or bandaging of theeye is not necessary and therefore multi­ple chalazia in eyelids of both sides can bemanaged in the same sitting. Bleedingand pain are minimal. The patients mustcome to the hospital only once and rarelya second time. The risk of damage to thelacrimal canaliculi and posterior border ofthe eyelid margins by surgery on chalaziasituated near the medial canthus (Figure)or eyelid margins is totally eliminated bythis method. It has a high patient accept­ance and reduces the cost of therapyconsiderably.

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 ef­

fective in the prevention and treatment ofchemically induced carcinogenesis in cer­tain experimental animal models;' Al­though success has been limited primari­ly to chemically induced carcinogenesis,one study demonstrated the inhibitoryeffect of retinol palmitate on the subcuta­neous growth of the S91 Cloudman mela­noma in Balb/C mice.f Retinoblastoma ofthe Y79 cell line is known to have solublereceptors for retinol and retinoic acid."Retinoids are cytotoxic in tissue cultureto these cells." These observationsprompted us to evaluate the in vivo effica­cy of retinoids in the inhibition of ocularmelanoma and retinoblastoma in animalmodels:

We used "nude" mice (animals with adeficit in cellular immunity) to test the

inhibitory potential of vitamin A on reti­noblastoma. Details of this model havebeen published previously." Three ret­inoids (retinol, 13-cis retinoic acid, andretinol palmitate) were tested with totaldoses of 0.1 mg, 1 mg, and 75 mg peranimal respectively. These were givenintraperitoneally in ten divided doses at48-hour intervals. Retinoblastoma cellswere transferred to the nude mice on theday of the fifth injection." There was nosignificant difference between the rate oftumor induction in the experimental andcontrol animals treated with retinol (nineof 16 vs six of 12 eyes), 13-cis retinoic acid(ten of 20 vs 12 of 20 eyes), or retinolpalmitate (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. Inthe first, Syrian hamsters received200,000 units of retinol palmitate, divid­ed into ten doses and injected intraperi­toneally at 48-hour intervals. Five injec­tions were given before tumor challengewith 1 X 105 Green hamster melanomacells injected into the posterior segmentof the eye. There was no significant dif­ference in the rate of tumor inductionbetween the experimental (nine of 16eyes) and control (six of 12 eyes) ani­mals.

Next, approximately 1 X 105 Cloudmanmelanoma cells were injected into theposterior segment of Balb/C mice andwere given subcutaneously after a totaldose of 50,000 units of retinol palmitateadministered as described. There was anidentical rate of tumor induction (28 of92eyes) in the experimental and controlgroups. Additionally, we did not demon­strate a significant inhibition of subcuta­neous growth of melanoma (29 of 100tumor takes in the experimental group vs24 of 110 tumor takes in the controlgroup).

In the nude mouse, the difference be­tween in vivo and in vitro efficacy of