A324 World Ophthalmology Congress 2008 Clinical and Experimental Ophthalmology 2008; 36 (Suppl 1): A324–A340 Journal Compilation © Blackwell Publishing Asia POSTERS Ocular Tumors, Pathology tor. Nine months following therapy the vision was stable and one focus of the tumour had regressed in the affected eye. The favourable response highlights the significant impact of this new therapy, as an alternative to external beam radiotherapy in patients with ocular metastasis from breast cancer. Poster No.: OT-D1-432 Panel No.: 432 An Unusual Presentation of Merkel Cell Carcinoma of the Eyelid First Author: Habiba Saedon Purpose: Merkel cell carcinoma is a rare primary neuroendocrine tumour occurring on any part of the body which mainly affects elderly Caucasians. Its importance lies in the potentially aggressive nature of the neoplasm, and subsequent need for prompt diagnosis and treatment. We describe an unusual presentation of this tumour. Method: This is a case report of a 68 year old Caucasian lady who presented with a 6 week history of a rapidly growing lesion on the left lower eyelid. Examination showed a 4 cm diameter exophytic, ovoid skin lesion of the left lower lid. She underwent local excision with intraoperative frozen-section monitoring of the resection margins. Histology findings were consistent with Merkel cell car- cinoma. Further wide local excision was undertaken and she under- went adjuvant chemotherapy. The clinical follow-up at 8 months revealed an undisturbed eye lid function without any signs of recur- rence. Results: Merkel cell carcinoma was first described in 1972 by Toker. The tumour usually presents as a firm, non-tender, viola- ceous, or purple nodule but, as in this case, may present in a dif- ferent guise. A high index of suspicion is therefore recommended in a rapidly growing lesion. There is no consensus on the optimal treatment, but most guidelines include wide local excision of the primary tumour alone or with radiation therapy. There is still con- troversy surrounding the use of chemotherapy. Sentinel lymph node biopsy can be helpful in staging and prognosis, but its benefit in survival has not been proven. In the largest study of 110 patients, the overall 5-year disease-specific survival rate was 62%. Conclu- sion: Merkel cell carcinoma is an important diagnosis to consider when presented with a lid lesion. Prompt investigation, diagnosis and treatment are of utmost importance to ensure the best chance of survival. Poster No.: OT-D1-433 Panel No.: 433 Direct Retinal Toxicity as a Cause of Vision Loss after Administration of Fludarabine First Author: Xiaoyan Ding Co-Author(s): Rachel Bishop, Charles Heller, Gabor Illei, Rafael Caruso, Steven Pavletic, Chi-Chao Chan Purpose: Fludarabine phosphate is a nucleoside analogue that has been used primarily to treat hematologic malignancies. Fludarabine toxicity to the central nervous system (CNS) has been described with moderate frequency at high doses and rarely at standard (low) June 28, 2008 (Saturday) Poster No.: OT-D1-430 Panel No.: 430 Visual Acuity in 3422 Consecutive Eyes with Choroidal Nevus First Author: Carol Shields Co-Author(s): Minoru Furuta, Arman Mashayekhi, Jonathan Zahler, Edwina Berman, Daniel Hoberman, Diep Dinh, Jerry A Shields Purpose: To evaluate visual acuity in eyes with choroidal nevus. Design: Noncomparative case series. Participants: 3422 consecu- tive eyes. Method: Retrospective chart review with evaluation of visual acuity at the time of presentation and at final examination. Main outcome measure: LogMAR visual acuity. Results: The mean patient age at initial examination was 60 years (median 62 years, range 1 to 97 years). At initial examination, mean LogMAR visual acuity was 0 (20/20) for eyes with extrafoveal choroidal nevus and 0.10 (20/25) for eyes with subfoveal choroidal nevus. At mean fol- lowup of 3.3 years (up to 36.2 years) months, final mean LogMAR visual acuity was 10 (20/25) for eyes with extrafoveal choroidal nevus and 0.18 (20/30) for eyes with subfoveal nevus. Using Kaplan Meier estimates, vision loss of 3 or more lines at 2, 5, 10, and 15 years occurred in <1%, <1%, 1%, and 2% of eyes with extrafoveal nevus compared to 4%, 11%, 20%, and 29% of subfoveal choroidal nevus. Conclusion: Mild vision loss over many years should be anticipated in patients with subfoveal choroidal nevus. Poster No.: OT-D1-431 Panel No.: 431 Uveal and Optic Nerve Metastasis from HER2 Poitive Breast Carcinoma and the Response to Combination Therapy with Paclitaxel and Trastuzumab First Author: Konstantinos Papageorgiou Co-Author(s): Alexander Ioannidis, Matthew Kinsella, Ajay Sinha, Petros Andreou, Neville Davidson Purpose: Breast cancer is the most common tumour to metastasize to the uveal tract. The mean survival period after diagnosis of metastasis to the eye ranges from 10 to 32 months but recent advances in therapy including monoclonal antibodies will hopefully improve treatment outcomes and prolong survival rates. Method: We report the case of a 45 year old woman with a HER2 positive breast cancer who developed two metastatic lesions on the left choroid as well as optic nerve sheath involvement. She underwent treatment with a combination of chemotherapy (Taxol) and anti- HER2 monoclonal antibodies (Herceptin). Results: Nine months later a B-scan showed resolution of the superior focus as well as absence of blood flow within the optic nerve sheath. The infer- onasal lesion was still present but the dimensions were reduced. Conclusion: The patient underwent a combined treatment of chemotherapy and Herceptin to increase the response rate. Trastuzumab (Herceptin) is a humanized monoclonal antibody which binds to the extracellular segment of the HER2/neu recep-