Objective: To report different histopathological types of basal cell carcinoma (BCC) involving the periocular region correlating with location and age. Methods: A retrospective analysis was performed on eyelid specimens obtained from the Henry C. Witelson Ophthalmic Pathology Registry, Canada over a 15-year period. The lesions were classified according the histopathological subtypes in nodular, nodular with sebaceous differentiation, nodular with squamous (Basosquamous) differentiation and sclerosing or morphea type. The mean age was evaluated for each subtype and correlation with location was made, whereas the lesions presented on the lower or upper eyelid, medial or lateral canthus. The statistical analysis was made using the unpaired t-test. Results: There were 4313 eyelid lesions analyzed over a 15-year period. Of those, 323 (7.48%) were BCCs. Two hundred and eighty two (87.30%) were nodular, 15 (4.64%) were nodular with squamous differentiation, 3 (0.92%) were nodular with sebaceous differentiation and 23 (7.12%) were of the sclerosing type. The overall most common location was the lower lid in 236 (73.06%) cases, followed by upper lid in 44 (13.75%), medial canthus in 32 (9.9%) and lateral canthus in 2 (0.61%) lesions. Nine BCCs (2.78%) had uncertain location. When the histopathological subtypes were evaluated individually the following results were obtained: In the nodular group, 207 (73.4%) lesions were located on the lower lid, 37 (13.12%) in the upper lid, 28 (9.92%) in the medial canthus and 2 (0.7%) in the lateral canthus. In the basosquamous group, 9 (60%) were in the lower lid, 5 (33.33%) in the upper lid, 1 (6.66%) in the medial canthus and no lesions were found in the lateral canthus. In the nodular with sebaceous differentiation group, 2 (66.66%) lower lid and 1 (33.33%) medial canthal lesions were found. In the sclerosing type group, 18 (78.26%) were in the lower lid, 2 (8.69%) in both the upper lid and medial canthus, with no lesions located on the lateral canthal region. Comparing the mean age of each histopathological type, the group of patients with basosquamous carcinoma was the youngest (62.53 years +/- 16.8 years), followed by the group with nodular BCC (65.28 years +/- 15.9 years), and patients with BCC with sebaceous differentiation (67 years +/- 13.14 years), and for the oldest group composed by patients with sclerosing BCC (75.65 years +/- 11.72 years). There were statistically significant values comparing sclerosing BCC with, nodular BCC (p value= 0.0018) and basosquamous carcinoma (p value= 0.0092) using the unpaired t-test Conclusions: In this single center study the incidence and anatomic location of the different histopathological subtypes of basal cell carcinoma were clearly identified. The data presented is of importance when approaching a patient with a suspect periocular lesion. Nodular BCC was the most common histopathological subtype and the preferred location was the lower lid followed by the upper lid. An older age on presentation was associated with the sclerosing subtype, indicating a more aggressive disease with worse prognosis. Furthermore, all suspect lesions should be excised with careful examination of the histopathological subtype. Resumo Objetivo: Reportar diferentes subtipos histopatológicos de carcinoma basocelular (CBC) acometendo a região periocular correlacionando-os com suas localizações e idades. Materiais/Métodos: Análise retrospectiva foi realizada a partir das lesões palpebrais obtidas do Henry C. Witelson Ophthalmic Pathology Registry, Canada, em um período de 15 anos. Os espécimes estudados foram classificados de acordo com o subtipo histopatológico em nodular, nodular com diferenciação escamosa, nodular com diferenciação sebácea e esclerosante ou morfeaforme. A determinação da localização em pálpebra inferior, pálpebra superior, canto medial e canto lateral foi realizada, correlacionando a idade média com cada subtipo histopatológico. A análise estatística foi realizada utilizando o teste t não-pareado. Resultados: Foram analisadas 4.313 lesões palpebrais em um período de 15 anos. O CBC da região periocular foi encontrado em 323 (7,48%) das lesões estudadas. Dos 323 casos, 282 (87.30%) eram do subtipo nodular, 15 (4.64%) nodular com diferenciação escamosa, 3 (0.92%) nodular com diferenciação sebácea e 23 (7.12%) esclerosante. A pálpebra inferior foi o local mais frequentemente acometido em 236 (73.06%) dos casos, seguido pela pálpebra superior em 44 (13.75%), canto medial em 32 (9.9%) e canto lateral em 2 (0.61%) dos casos. Cinco (1,54%) casos tiveram localização incerta e 4 (1,23%) foram casos de exenteração. Avaliando cada subtipo histopatológico os resultados foram: Nos casos de CBC nodular, 207 (73.4%) foram localizados na pálpebra inferior, 37 (13.12%) na pálpebra superior, 28 (9.92%) no canto medial e 2 (0.7%) no canto lateral. Nos casos de CBC nodular com diferenciação escamosa, 9 (60%) foram localizados na pálpebra inferior, 5 (33.33%) na pálpebra superior, 1 (6.66%) no canto medial e nenhuma lesão foi encontrada no canto lateral. Nos casos de CBC nodular com diferenciação sebácea, 2 (66.66%) foram localizados na pálpebra inferior e 1 (33.33%) no canto medial. Nos casos de CBC esclerosante, 18 (78.26%) foram localizados na pálpebra inferior, 2 (8.69%) na pálpebra superior e canto medial e nenhum caso foi encontrada no canto lateral. Comparando a idade média de cada subtipo histopatológico, os pacientes apresentando CBC nodular com diferenciação escamosa foram os mais jovens (62.53 anos +/- 16.8 anos), seguidos pelo grupo com CBC nodular (65.28 anos +/- 15.9 anos), CBC nodular com diferenciação sebácea (67 anos +/- 13.14 anos), e com o tipo esclerosante apresentando idade média mais elevada (75.65 anos +/- 11.72 anos). Foi observada diferença estatisticamente significativa comparando as idades médias entre os pacientes com CBC esclerosante e nodular (p = 0.0018) e entre CBC esclerosante e nodular com diferenciação escamosa (p= 0.0092). Conclusão: No presente estudo realizado em centro único, a incidência e localização anatômica dos diferentes subtipos histopatológicos de carcinoma basocelular foi claramente identificada. Os dados encontrados são importantes na avaliação de pacientes com lesões perioculares suspeitas. O CBC nodular foi o subtipo histopatológico mais encontrado e sua localização preferencial foi a pálpebra inferior, seguida pela pálpebra superior. A idade mais elevada foi associada com o subtipo esclerosante, indicando doença mais agressiva com pior prognóstico. Por conseguinte, todas as lesões suspeitas devem ser excisadas e análise histopatológica cuidadosa realizada para caracterização do subtipo histopatológico.

Objective: To present the outcomes of 4 patients with Acanthamoeba keratitis (AK) who underwent combined penetrating keratoplasty and cataract extraction (PKP/CE) after medical treatment of their infection. Method: Retrospective case series. 4 patients with AK underwent PKP/CE after medical control of infection was achieved. Results: The mean time from control of infection to surgery was 4 months. Three patients maintained a clear graft after a mean follow up of one year. One patient with bilateral sclerokeratitis who underwent bilateral PKP had recurrent infection in the right eye and required a repeat transplant 7 months after her initial transplant for visual rehabilitation. Conclusion: PK with lens extraction is a good approach for visual rehabilitation in patients with a history of AK after complete control of infection with medical treatment. Resumen Objetivo: Presentar 4 casos de queratitis por acanthamoeba (QA) y su manejo médico-quirúrgico en el proceso de rehabilitación visual. Método: Se realizó un estudio retrospectivo. Se incluyeron 4 pacientes con diagnóstico de QA que fueron sometidos a queratoplastia penetrante con extracción del cristalino (QP/EC) luego de obtenida la estabilidad clínica con un tratamiento médico agresivo. Resultados: El tiempo medio en lograr estabilidad clínica fue de 4 meses. 3 casos presentaron injerto corneal transparente con más de una año de seguimiento. 1 paciente con escleroqueratitis bilateral, sometido a QP bilateral, presentó un cuadro de recurrencia amebiana. Dicho paciente requirió una segunda QP en ojo derecho luego de 7 meses de la primera para su correcta rehabilitación visual. Conclusión: La QP/EC es una muy buena opción para la rehabilitación visual en pacientes con antecedentes de QA posterior al control completo de la infección mediante tratamiento médico.