Pub Date : 2024-09-01Epub Date: 2024-05-31DOI: 10.1159/000539488
David H Abramson, Jacquelyn Gaccione, Christina Bracken, Todd Liu, Edith Guarini, Andrea Bobin, Angela Foerch, Melissa A Robbins, Ricardo Dodds Rojas, Jasmine H Francis
Introduction: Children with retinoblastoma have anesthesia for exams and treatment, but there is little information about how long treatment interventions (laser, cryotherapy, and intravitreal injections) add to routine exams under anesthesia (EUA). This information would be useful for planning operating room schedules, staff schedules, family expectations, and billing.
Methods: A retrospective, single-center, Institutional Review Board (IRB) approved review of anesthesia duration for retinoblastoma children undergoing EUA with laser, cryotherapy, or intravitreal injections performed at MSK between January 2019 and November 2023.
Results: Three hundred eight patients had 2,399 EUAs. The average EUA lasted 24.3 min (range 7-77 min) when no interventions were done. Laser photocoagulation added an average of 18.9 min (range 19-77 min), cryotherapy 26.1 min (range 27-75 min), and intravitreal injection 23.5 min (range 10-71 min) to the basic EUA time. Bilateral laser treatments took 8 min longer than unilateral treatments.
Conclusion: EUAs for children with retinoblastoma can be performed relatively quickly. Interventions such as laser, cryotherapy, or intravitreal injections roughly double the time under anesthesia but in some cases can take much longer (>1 h).
{"title":"How Much Time Do Focal Treatments for Retinoblastoma Add to Anesthetic Exposure?","authors":"David H Abramson, Jacquelyn Gaccione, Christina Bracken, Todd Liu, Edith Guarini, Andrea Bobin, Angela Foerch, Melissa A Robbins, Ricardo Dodds Rojas, Jasmine H Francis","doi":"10.1159/000539488","DOIUrl":"10.1159/000539488","url":null,"abstract":"<p><strong>Introduction: </strong>Children with retinoblastoma have anesthesia for exams and treatment, but there is little information about how long treatment interventions (laser, cryotherapy, and intravitreal injections) add to routine exams under anesthesia (EUA). This information would be useful for planning operating room schedules, staff schedules, family expectations, and billing.</p><p><strong>Methods: </strong>A retrospective, single-center, Institutional Review Board (IRB) approved review of anesthesia duration for retinoblastoma children undergoing EUA with laser, cryotherapy, or intravitreal injections performed at MSK between January 2019 and November 2023.</p><p><strong>Results: </strong>Three hundred eight patients had 2,399 EUAs. The average EUA lasted 24.3 min (range 7-77 min) when no interventions were done. Laser photocoagulation added an average of 18.9 min (range 19-77 min), cryotherapy 26.1 min (range 27-75 min), and intravitreal injection 23.5 min (range 10-71 min) to the basic EUA time. Bilateral laser treatments took 8 min longer than unilateral treatments.</p><p><strong>Conclusion: </strong>EUAs for children with retinoblastoma can be performed relatively quickly. Interventions such as laser, cryotherapy, or intravitreal injections roughly double the time under anesthesia but in some cases can take much longer (>1 h).</p>","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"10 3","pages":"182-188"},"PeriodicalIF":0.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-04-29DOI: 10.1159/000538537
Tatsuya Yunoki, Akio Miyakoshi, Atsushi Hayashi
Introduction: The aim of the study was to evaluate the clinicopathological features of eyelid sebaceous gland carcinoma (SGC), which requires immunohistochemical examination for a definitive diagnosis.
Methods: Twenty-seven patients with a final diagnosis of eyelid SGC at Toyama University Hospital between April 2016 and April 2022 were retrospectively studied. In cases with a strong clinical suspicion of SGC, if the initial pathological diagnosis by hematoxylin-eosin staining was non-SGC, additional detailed pathology was performed, including immunostaining for adipophilin (ADP) and androgen receptor (AR).
Results: Five patients (18.5%) had a diagnosis other than SGC, including three with squamous cell carcinoma (SCC), one with basal cell carcinoma, and one with Bowen disease. In these 5 cases, detailed pathology, including immunostaining for ADP and AR, was performed again, which ultimately led to the diagnosis of SGC. ADP was positive in all 5 cases, and AR was positive in 4 cases. The 3 patients diagnosed with SCC were characterized by a high Ki-67 index, active mitosis, and relatively low differentiation.
Conclusion: SGC can be pathologically diagnosed in other cancers, such as SCC and BCC. When SCC was diagnosed, it was often hypo-differentiated and required more attention. Immunostaining for ADP and AR is invaluable for confirming SGC diagnosis.
{"title":"Clinicopathologic Features of Eyelid Sebaceous Gland Carcinoma Requiring Immunohistochemical Diagnosis.","authors":"Tatsuya Yunoki, Akio Miyakoshi, Atsushi Hayashi","doi":"10.1159/000538537","DOIUrl":"10.1159/000538537","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to evaluate the clinicopathological features of eyelid sebaceous gland carcinoma (SGC), which requires immunohistochemical examination for a definitive diagnosis.</p><p><strong>Methods: </strong>Twenty-seven patients with a final diagnosis of eyelid SGC at Toyama University Hospital between April 2016 and April 2022 were retrospectively studied. In cases with a strong clinical suspicion of SGC, if the initial pathological diagnosis by hematoxylin-eosin staining was non-SGC, additional detailed pathology was performed, including immunostaining for adipophilin (ADP) and androgen receptor (AR).</p><p><strong>Results: </strong>Five patients (18.5%) had a diagnosis other than SGC, including three with squamous cell carcinoma (SCC), one with basal cell carcinoma, and one with Bowen disease. In these 5 cases, detailed pathology, including immunostaining for ADP and AR, was performed again, which ultimately led to the diagnosis of SGC. ADP was positive in all 5 cases, and AR was positive in 4 cases. The 3 patients diagnosed with SCC were characterized by a high Ki-67 index, active mitosis, and relatively low differentiation.</p><p><strong>Conclusion: </strong>SGC can be pathologically diagnosed in other cancers, such as SCC and BCC. When SCC was diagnosed, it was often hypo-differentiated and required more attention. Immunostaining for ADP and AR is invaluable for confirming SGC diagnosis.</p>","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"10 3","pages":"131-138"},"PeriodicalIF":0.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amizatul Aini Salleh, Y. Krishna, Sarah E. Coupland
Introduction: Periocular sebaceous carcinoma (PSC) remains a common diagnostic pitfall both clinically and histomorphologically. PRAME (PReferentially Expressed Antigen in MElanoma) has been studied in the various neoplasms as proposed as diagnostic and therapeutic markers. PRAME is expressed in normal sebaceous units and in some sebaceous lesions; however, its utility in sebaceous carcinoma diagnosis has not yet been extensively investigated. We conducted a 13-year retrospective review of the patients diagnosed with PSC at the National Specialist Ophthalmic Pathology Service in Liverpool. Herein, we report the histomorphological and immunohistochemical (IHC) features of these tumors, particularly PRAME expression in this cohort. Methods: Thirty-one PSC cases diagnosed between 2009 to 2022 were retrieved from the histopathology archives. Twenty cases diagnosed as invasive PSC and 11 cases with in-situ PSC were included. The hematoxylin and eosin (H&E) slides and previously-performed IHC slides were reviewed; clinical information data were obtained. Cases with an adequate tissue were also stained for PRAME (PReferentially expressed Antigen in MElanoma) and adipophilin (if not already performed). Results: In total, there were 24 females and 7 males diagnosed with PSC, ranging from 55 to 90 years (median, 78 years). The types of specimens received were: 11 conjunctival mapping biopsies, 19 excisions/wedge resections, and 1 orbital exenteration. The eyelid was the commonest site involved (n=24), followed by eyelid with conjunctiva (3), and conjunctiva alone (4). All patients presented with the clinical suspicion of malignancy. Histologically, 11 invasive PSC (55%) exhibited poorly differentiated morphology, composed of predominantly atypical basaloid cells with minimal sebocytic differentiation; 9 cases (45%) were moderately-differentiated with noticeable finely multivacuolated cytoplasm; and 3 (15%) showed associated comedo-necrosis. Most invasive PSC showed moderate to brisk mitotic activities. Of those cases with available immunostains (n=31), 25 (80.6%) expressed adipophilin; 18 (58.1%) Ber-EP4; 14 (45.2%) epithelial membrane antigen (EMA); and 5 (16.1%) both androgen receptor and perforin positivity. PRAME expression was seen in normal sebaceous glands; however, only (5/19; 26%) of invasive PSC showed focal weak-to-moderate PRAME positivity, and mostly in moderately-differentiated tumors. None of the in-situ PSC were PRAME positive. Conclusions: Most PSC are moderate- to poorly-differentiated. Although PRAME is expressed in normal sebaceous units, it appears less useful as diagnostic marker for PSC, especially in poorly-differentiated tumors. In difficult cases, panels of immunohistochemical studies (Adipophilin, Ber-EP4 and EMA) achieve a definitive diagnosis.
{"title":"Periocular Sebaceous Carcinoma: case audit from the National Specialist Ophthalmic Pathology Service in Liverpool from 2009 to 2022, to assess the diagnostic utility of PRAME expression.","authors":"Amizatul Aini Salleh, Y. Krishna, Sarah E. Coupland","doi":"10.1159/000535169","DOIUrl":"https://doi.org/10.1159/000535169","url":null,"abstract":"Introduction: Periocular sebaceous carcinoma (PSC) remains a common diagnostic pitfall both clinically and histomorphologically. PRAME (PReferentially Expressed Antigen in MElanoma) has been studied in the various neoplasms as proposed as diagnostic and therapeutic markers. PRAME is expressed in normal sebaceous units and in some sebaceous lesions; however, its utility in sebaceous carcinoma diagnosis has not yet been extensively investigated. \u0000We conducted a 13-year retrospective review of the patients diagnosed with PSC at the National Specialist Ophthalmic Pathology Service in Liverpool. Herein, we report the histomorphological and immunohistochemical (IHC) features of these tumors, particularly PRAME expression in this cohort.\u0000\u0000Methods: Thirty-one PSC cases diagnosed between 2009 to 2022 were retrieved from the histopathology archives. Twenty cases diagnosed as invasive PSC and 11 cases with in-situ PSC were included. The hematoxylin and eosin (H&E) slides and previously-performed IHC slides were reviewed; clinical information data were obtained. Cases with an adequate tissue were also stained for PRAME (PReferentially expressed Antigen in MElanoma) and adipophilin (if not already performed). \u0000\u0000Results: In total, there were 24 females and 7 males diagnosed with PSC, ranging from 55 to 90 years (median, 78 years). The types of specimens received were: 11 conjunctival mapping biopsies, 19 excisions/wedge resections, and 1 orbital exenteration. The eyelid was the commonest site involved (n=24), followed by eyelid with conjunctiva (3), and conjunctiva alone (4). All patients presented with the clinical suspicion of malignancy. \u0000Histologically, 11 invasive PSC (55%) exhibited poorly differentiated morphology, composed of predominantly atypical basaloid cells with minimal sebocytic differentiation; 9 cases (45%) were moderately-differentiated with noticeable finely multivacuolated cytoplasm; and 3 (15%) showed associated comedo-necrosis. Most invasive PSC showed moderate to brisk mitotic activities. \u0000Of those cases with available immunostains (n=31), 25 (80.6%) expressed adipophilin; 18 (58.1%) Ber-EP4; 14 (45.2%) epithelial membrane antigen (EMA); and 5 (16.1%) both androgen receptor and perforin positivity. PRAME expression was seen in normal sebaceous glands; however, only (5/19; 26%) of invasive PSC showed focal weak-to-moderate PRAME positivity, and mostly in moderately-differentiated tumors. None of the in-situ PSC were PRAME positive. \u0000\u0000Conclusions: Most PSC are moderate- to poorly-differentiated. Although PRAME is expressed in normal sebaceous units, it appears less useful as diagnostic marker for PSC, especially in poorly-differentiated tumors. In difficult cases, panels of immunohistochemical studies (Adipophilin, Ber-EP4 and EMA) achieve a definitive diagnosis.","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"128 ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew Camacho, Michael Antonietti, Yoseph Sayegh, Jordan D. Colson, Anne L. Kunkler, Kevin D. Clauss, Hannah Muniz-Castro, Wendy W. Lee, Sonia H. Yoo, Thomas E. Johnson, Sander R. Dubovy
Abstract Purpose Ocular dirofilariasis is an uncommon zoonotic infection that is usually associated with a carnivore host. In this case series and literature review we investigate the clinical presentation, management, and histopathology of ocular dirofilariasis. Methods The database at the Florida Lions Ocular Pathology Laboratory was searched for surgical specimens at the Bascom Palmer Eye Institute under approval of the institutional review board. Patients with a histopathologic diagnosis of dirofilariasis between the years of 1962 and 2022 from the Florida Lions Ocular Pathology laboratory database were included (n=3). A systematic Pubmed search was conducted by two independent authors to identify published cases of ophthalmic dirofilariasis worldwide. Keywords were used to identify articles and exclusion criteria were applied. Results Three patients, two males and one female, were identified from the Florida Lions Ocular Pathology database with a diagnosis of ocular dirofilariasis. The mean age was 46.7 years (with a range 33-57 years). There were two eyelid lesions (Cases 1 and 3) and one involving the subconjunctival space (Case 2). All three organisms were excised and presumptively identified as Dirofilaria tenuis. All three patients were managed with curative surgical removal and recovered completely. Our review of the literature identified 540 published reports with 142 published reports with 186 cases met the exclusion criteria. Conclusion We present a case series and literature review of ocular dirofilariasis. Knowledge of the incidence, risk factors, prevention and diagnosis of this unique parasitic infection will help in proper management and prevent further ocular complications.
{"title":"Ocular dirofilariasis: a clinicopathologic case series and literature review","authors":"Matthew Camacho, Michael Antonietti, Yoseph Sayegh, Jordan D. Colson, Anne L. Kunkler, Kevin D. Clauss, Hannah Muniz-Castro, Wendy W. Lee, Sonia H. Yoo, Thomas E. Johnson, Sander R. Dubovy","doi":"10.1159/000533340","DOIUrl":"https://doi.org/10.1159/000533340","url":null,"abstract":"Abstract \u0000Purpose\u0000Ocular dirofilariasis is an uncommon zoonotic infection that is usually associated with a carnivore host. In this case series and literature review we investigate the clinical presentation, management, and histopathology of ocular dirofilariasis. \u0000Methods\u0000The database at the Florida Lions Ocular Pathology Laboratory was searched for surgical specimens at the Bascom Palmer Eye Institute under approval of the institutional review board. Patients with a histopathologic diagnosis of dirofilariasis between the years of 1962 and 2022 from the Florida Lions Ocular Pathology laboratory database were included (n=3). \u0000A systematic Pubmed search was conducted by two independent authors to identify published cases of ophthalmic dirofilariasis worldwide. Keywords were used to identify articles and exclusion criteria were applied. \u0000Results\u0000Three patients, two males and one female, were identified from the Florida Lions Ocular Pathology database with a diagnosis of ocular dirofilariasis. The mean age was 46.7 years (with a range 33-57 years). There were two eyelid lesions (Cases 1 and 3) and one involving the subconjunctival space (Case 2). All three organisms were excised and presumptively identified as Dirofilaria tenuis. All three patients were managed with curative surgical removal and recovered completely. \u0000Our review of the literature identified 540 published reports with 142 published reports with 186 cases met the exclusion criteria.\u0000Conclusion\u0000We present a case series and literature review of ocular dirofilariasis. Knowledge of the incidence, risk factors, prevention and diagnosis of this unique parasitic infection will help in proper management and prevent further ocular complications.","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"85 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139010729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Contents Vol. 9, 2023","authors":"Arun D. Singh, H. Grossniklaus","doi":"10.1159/issn.2296-4657","DOIUrl":"https://doi.org/10.1159/issn.2296-4657","url":null,"abstract":"","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"396 2","pages":"I - IV"},"PeriodicalIF":1.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138993730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kenny Y. Wang, Timothy T. Xu, Launia J. White, Lauren A. Dalvin
Introduction: To determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) billing codes for identifying ocular oncology diagnoses. Methods: Population-based retrospective cohort study of all Olmsted County, Minnesota residents with any ocular neoplasm-related ICD-9 code from January 1, 2006 to October 1, 2015. All medical records were reviewed for confirmation of ocular neoplasm. Diagnoses with ≥5 cases confirmed via medical record review were compared to corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes. Results: Among 3,932 subjects with ≥1 ocular neoplasm-related ICD-9 code, 21 diagnoses met study criteria. The most frequent intraocular, extraocular/orbital, and ocular surface diagnoses were choroidal nevus (n=824), epidermal inclusion cyst (n=263), and conjunctival nevus (n=74), respectively. PPVs ranged from 1.2% to 73.8%, NPVs from 96.9% to 100%, sensitivity from 0% to 100%, and specificity from 85.7% to 100%. Among malignant neoplasms, PPV ranged from 0% to 73.8%: ocular surface squamous neoplasia (PPV: 0%), choroidal melanoma (PPV: 25.0%), eyelid squamous cell carcinoma (PPV: 46.7%), and eyelid basal cell carcinoma (PPV: 73.8%). Among benign neoplasms, PPV ranged from 1.2% (dermoid cyst) to 61.6% (choroidal nevus). Conclusion: There was wide variation in predictive value of ocular neoplasm-related ICD-9 billing codes, which suggests that ocular oncology-related claims data alone may overestimate the true number of ocular oncology diagnoses.
{"title":"Predictive Value of the International Classification of Diseases, 9th Revision Codes for Identifying Ocular Oncology Diagnoses","authors":"Kenny Y. Wang, Timothy T. Xu, Launia J. White, Lauren A. Dalvin","doi":"10.1159/000534688","DOIUrl":"https://doi.org/10.1159/000534688","url":null,"abstract":"Introduction: To determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) billing codes for identifying ocular oncology diagnoses. Methods: Population-based retrospective cohort study of all Olmsted County, Minnesota residents with any ocular neoplasm-related ICD-9 code from January 1, 2006 to October 1, 2015. All medical records were reviewed for confirmation of ocular neoplasm. Diagnoses with ≥5 cases confirmed via medical record review were compared to corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes. Results: Among 3,932 subjects with ≥1 ocular neoplasm-related ICD-9 code, 21 diagnoses met study criteria. The most frequent intraocular, extraocular/orbital, and ocular surface diagnoses were choroidal nevus (n=824), epidermal inclusion cyst (n=263), and conjunctival nevus (n=74), respectively. PPVs ranged from 1.2% to 73.8%, NPVs from 96.9% to 100%, sensitivity from 0% to 100%, and specificity from 85.7% to 100%. Among malignant neoplasms, PPV ranged from 0% to 73.8%: ocular surface squamous neoplasia (PPV: 0%), choroidal melanoma (PPV: 25.0%), eyelid squamous cell carcinoma (PPV: 46.7%), and eyelid basal cell carcinoma (PPV: 73.8%). Among benign neoplasms, PPV ranged from 1.2% (dermoid cyst) to 61.6% (choroidal nevus). Conclusion: There was wide variation in predictive value of ocular neoplasm-related ICD-9 billing codes, which suggests that ocular oncology-related claims data alone may overestimate the true number of ocular oncology diagnoses.","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134907523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khanh Bui, Maurizio Tomaiolo, Kaylene Carter, Codrin Iacob, Vamsee Neerukonda, Anna Stagner, Zaynab Sajjadi, Katherine V. Escobar, Paula Ordoñez Armijos, Ralph C. Eagle, Sonia Mehta, James P. Dunn, Leslie Hyman, Tatyana Milman
Introduction: Sympathetic ophthalmia (SO) is a rare bilateral granulomatous panuveitis that can follow surgical or non-surgical ocular trauma in one eye. Because its diagnosis requires clinical-pathologic correlation, the true incidence of SO is unknown, and there is a need to understand the recent trends in risk factors and frequency of this condition. Methods: Pathology records of all enucleated or eviscerated (ENEV) eyes at three pathology laboratories were reviewed. Data collected included patient demographics, procedure indication, pathology diagnosis, and clinical history of trauma and uveitis. IRIS® Registry (Intelligent Research in Sight) was searched for all patients with SO, acquired absence of eye (AAE), and/or ENEV. Data obtained included patient demographics, ocular procedures, and preoperative diagnoses within 30 days of AAE/ENEV. Results: In the pathology laboratory setting, the incidence of SO over a 36-year period in patients who underwent ENEV was 0.2% (20/9,092); the 5-year incidence ranged from 0.0-0.3%. Among the 20 eyes with SO, the inciting event was surgical trauma in 50% (10/20), non-surgical trauma in 45% (9/20), and missing/undetermined in 5% (1/20). SO was suspected pre-operatively in 7/20 (35%) patients. Clinical concern for SO and ruptured globe were indications for ENEV in 50/9,092 (0.5%) and 872/9,092 (10%) patients, respectively. In the IRIS Registry, 0.7% (199/27,830) of patients with AAE/ENEV had diagnosis of SO. The frequency of SO between 2015-2020 was 0.01% (7,371/62,318,249); of these 7,371 cases, 199 (3%) had AAE/ENEV. In 25,975 patients with available data, injury and SO were listed as diagnoses less than 30 days prior to AAE/ENEV in 909 (4%) and 63 (0.2%) cases, respectively. Discussion/Conclusion: The frequency of SO in recent decades is low. Most cases of SO are not managed with eye removal. In histopathology-confirmed SO, surgical trauma is as frequent as non-surgical trauma as an inciting etiology of disease.
交感性眼炎(SO)是一种罕见的双侧肉芽肿性全葡萄膜炎，可在单眼手术或非手术眼外伤后发生。由于其诊断需要临床病理相关性，SO的真实发病率尚不清楚，因此有必要了解这种疾病的危险因素和频率的最新趋势。方法:回顾三个病理实验室对所有去核或去内脏(ENEV)眼的病理记录。收集的资料包括患者人口统计、手术指征、病理诊断、创伤和葡萄膜炎的临床病史。IRIS®Registry (Intelligent Research in Sight)检索所有SO、获得性缺眼(AAE)和/或ENEV患者。获得的数据包括患者人口统计学、眼科手术和AAE/ENEV 30天内的术前诊断。结果:在病理实验室环境中，接受ENEV的患者36年期间SO的发生率为0.2% (20/9,092);5年发病率为0.0-0.3%。在20只眼SO中，50%(10/20)为手术损伤，45%(9/20)为非手术损伤，5%(1/20)为缺失/不确定。7/20(35%)患者术前怀疑有SO。在50/9,092(0.5%)和872/9,092(10%)患者中，临床对SO和球破裂的关注分别是ENEV的适应症。在IRIS注册中，0.7%(199/27,830)的AAE/ENEV患者被诊断为SO。2015-2020年SO发生率为0.01% (7371 / 62318249);7371例中，AAE/ENEV 199例(3%)。在25,975例可获得数据的患者中，909例(4%)和63例(0.2%)分别在AAE/ENEV发生前不到30天被诊断为损伤和SO。讨论/结论:近几十年来，SO的发生率较低。大多数SO病例不能通过摘除眼睛来治疗。在组织病理学证实的SO中，手术创伤与非手术创伤一样常见，是疾病的诱因。
{"title":"Sympathetic ophthalmia in patients with enucleation or evisceration: pathology laboratory and IRIS® Registry experience","authors":"Khanh Bui, Maurizio Tomaiolo, Kaylene Carter, Codrin Iacob, Vamsee Neerukonda, Anna Stagner, Zaynab Sajjadi, Katherine V. Escobar, Paula Ordoñez Armijos, Ralph C. Eagle, Sonia Mehta, James P. Dunn, Leslie Hyman, Tatyana Milman","doi":"10.1159/000533310","DOIUrl":"https://doi.org/10.1159/000533310","url":null,"abstract":"Introduction: Sympathetic ophthalmia (SO) is a rare bilateral granulomatous panuveitis that can follow surgical or non-surgical ocular trauma in one eye. Because its diagnosis requires clinical-pathologic correlation, the true incidence of SO is unknown, and there is a need to understand the recent trends in risk factors and frequency of this condition. Methods: Pathology records of all enucleated or eviscerated (ENEV) eyes at three pathology laboratories were reviewed. Data collected included patient demographics, procedure indication, pathology diagnosis, and clinical history of trauma and uveitis. IRIS® Registry (Intelligent Research in Sight) was searched for all patients with SO, acquired absence of eye (AAE), and/or ENEV. Data obtained included patient demographics, ocular procedures, and preoperative diagnoses within 30 days of AAE/ENEV. Results: In the pathology laboratory setting, the incidence of SO over a 36-year period in patients who underwent ENEV was 0.2% (20/9,092); the 5-year incidence ranged from 0.0-0.3%. Among the 20 eyes with SO, the inciting event was surgical trauma in 50% (10/20), non-surgical trauma in 45% (9/20), and missing/undetermined in 5% (1/20). SO was suspected pre-operatively in 7/20 (35%) patients. Clinical concern for SO and ruptured globe were indications for ENEV in 50/9,092 (0.5%) and 872/9,092 (10%) patients, respectively. In the IRIS Registry, 0.7% (199/27,830) of patients with AAE/ENEV had diagnosis of SO. The frequency of SO between 2015-2020 was 0.01% (7,371/62,318,249); of these 7,371 cases, 199 (3%) had AAE/ENEV. In 25,975 patients with available data, injury and SO were listed as diagnoses less than 30 days prior to AAE/ENEV in 909 (4%) and 63 (0.2%) cases, respectively. Discussion/Conclusion: The frequency of SO in recent decades is low. Most cases of SO are not managed with eye removal. In histopathology-confirmed SO, surgical trauma is as frequent as non-surgical trauma as an inciting etiology of disease.","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135646428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raquel Benavides, Ricardo Mejías, Alejandro Blanco, Luis Bermudez-Guzman
Introduction: Uveal melanoma is the most common primary intraocular malignancy in adults, affecting primarily the choroid of the eye. Plaque brachytherapy is the most common procedure for the treatment of small choroidal melanoma, especially in posteriorly located tumors. However, modern radiotherapy techniques, such as CyberKnife or Gamma knife stereotactic radiosurgery (SRS) and proton beam radiotherapy, have shown better results in tumor control and eye retention. Recent studies have indicated that SRS is a promising non-invasive, single-session treatment option, with most studies reporting the best outcomes when using ≥21–22 Gy. However, there is no consistent protocol for managing this pathology using CyberKnife, not only in terms of dose but also fractions. Case Presentations: Here, we report the first case series of patients (n = 4, age range 38–64 years, median age 52.5 years) with choroidal UM in Central America who were treated with CyberKnife SRS (22 Gy in one session). During the follow-up (range 25–29 months, median 27.5 months), a 100% control rate with no systemic metastatic disease has been achieved. We found a statistically significant reduction in the largest basal diameter at 24 months for all tumors. However, visual acuity has progressively decreased in most patients. Notably, two of our patients developed radiation maculopathy, and the other two developed radiation retinopathy after SRS. Conclusions: Our findings suggest that future studies should evaluate the use of different prophylactic therapies to prevent the development of side effects. The clinical management of toxicities presented in our report can serve as a reference in the clinical practice of other centers. Our report supports the growing body of evidence showing that CyberKnife radiosurgery is a safe and effective therapeutic option for the treatment of UM.
{"title":"CyberKnife Stereotactic Radiosurgery for Uveal Melanoma: First Case Series in Central America","authors":"Raquel Benavides, Ricardo Mejías, Alejandro Blanco, Luis Bermudez-Guzman","doi":"10.1159/000534207","DOIUrl":"https://doi.org/10.1159/000534207","url":null,"abstract":"<b><i>Introduction:</i></b> Uveal melanoma is the most common primary intraocular malignancy in adults, affecting primarily the choroid of the eye. Plaque brachytherapy is the most common procedure for the treatment of small choroidal melanoma, especially in posteriorly located tumors. However, modern radiotherapy techniques, such as CyberKnife or Gamma knife stereotactic radiosurgery (SRS) and proton beam radiotherapy, have shown better results in tumor control and eye retention. Recent studies have indicated that SRS is a promising non-invasive, single-session treatment option, with most studies reporting the best outcomes when using ≥21–22 Gy. However, there is no consistent protocol for managing this pathology using CyberKnife, not only in terms of dose but also fractions. <b><i>Case Presentations:</i></b> Here, we report the first case series of patients (<i>n</i> = 4, age range 38–64 years, median age 52.5 years) with choroidal UM in Central America who were treated with CyberKnife SRS (22 Gy in one session). During the follow-up (range 25–29 months, median 27.5 months), a 100% control rate with no systemic metastatic disease has been achieved. We found a statistically significant reduction in the largest basal diameter at 24 months for all tumors. However, visual acuity has progressively decreased in most patients. Notably, two of our patients developed radiation maculopathy, and the other two developed radiation retinopathy after SRS. <b><i>Conclusions:</i></b> Our findings suggest that future studies should evaluate the use of different prophylactic therapies to prevent the development of side effects. The clinical management of toxicities presented in our report can serve as a reference in the clinical practice of other centers. Our report supports the growing body of evidence showing that CyberKnife radiosurgery is a safe and effective therapeutic option for the treatment of UM.","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135084958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Frances Wu, Anne Marie Lane, Alexei Trofimov, Helen A. Shih, Evangelos S. Gragoudas, Ivana K. Kim
Introduction: Vision loss is common in patients treated with radiotherapy for uveal melanoma. With proton beam irradiation (PBI), the prescribed dose is delivered to the tumor with a sharp dose reduction outside the target volume. However, radiation complications are likely to develop when tumors are located near the optic nerve or fovea. Treatment with light-activated AU-011 (belzupacap sarotalocan), an investigational drug which specifically targets tumor cells, may avoid these complications. We evaluated outcomes in a historical group of patients who fit eligibility criteria for AU-011 therapy and were treated with PBI. Methods: A consecutive series of patients who received PBI for small choroidal melanoma at a single center between 1986 and 2016 were identified. Consistent with eligibility criteria in clinical trials of AU-011, patients were included when tumor dimensions did not exceed 2.5 mm in maximum thickness and 10.0 mm in largest basal diameter (LBD). Snellen visual acuities were converted to logMAR for analysis. Visual acuity outcomes were analyzed in patients with an initial acuity of logMAR 0.7 or better (equivalent to Snellen 20/100). Rates of visual acuity loss and mortality were calculated using the Kaplan-Meier method. Acuity loss by tumor location was compared using log-rank testing. Rates of tumor recurrence, neovascular glaucoma (NVG), and eye loss were also described. Results: Two hundred and 22 patients were included in the study. The median age was 60.7 years (range 21.3–94.8 years). Median tumor thickness was 2.0 mm (range 1.2–2.5 mm), and median LBD was 8.0 mm (range 4.0–10.0 mm). Median follow-up was 6.9 years (range 1.0–30.2 years). In 204 patients with a baseline logMAR visual acuity of 0.7 or better, the mean baseline acuity was 0.15 (equivalent to Snellen 20/25), which decreased to 0.52 (approximately Snellen 20/70) by 5 years after PBI. Visual outcomes were significantly worse for patients with tumors located within 3 mm of the optic disc and/or fovea. Tumor recurrence (1.4%), NVG (4.5%), and eye loss (2.7%) were uncommon. Discussion: Despite the advantageous dose distribution of protons, over half of patients with small choroidal melanomas located near the optic disc or fovea had a visual acuity equivalent to 20/80 or worse at 5 years after PBI. Treatment with AU-011 may allow better vision preservation in small tumors that carry a high risk of vision loss with radiotherapy.
{"title":"Outcomes after proton beam irradiation in patients with choroidal melanoma eligible for investigational AU-011 treatment","authors":"Frances Wu, Anne Marie Lane, Alexei Trofimov, Helen A. Shih, Evangelos S. Gragoudas, Ivana K. Kim","doi":"10.1159/000534184","DOIUrl":"https://doi.org/10.1159/000534184","url":null,"abstract":"<b><i>Introduction:</i></b> Vision loss is common in patients treated with radiotherapy for uveal melanoma. With proton beam irradiation (PBI), the prescribed dose is delivered to the tumor with a sharp dose reduction outside the target volume. However, radiation complications are likely to develop when tumors are located near the optic nerve or fovea. Treatment with light-activated AU-011 (belzupacap sarotalocan), an investigational drug which specifically targets tumor cells, may avoid these complications. We evaluated outcomes in a historical group of patients who fit eligibility criteria for AU-011 therapy and were treated with PBI. <b><i>Methods:</i></b> A consecutive series of patients who received PBI for small choroidal melanoma at a single center between 1986 and 2016 were identified. Consistent with eligibility criteria in clinical trials of AU-011, patients were included when tumor dimensions did not exceed 2.5 mm in maximum thickness and 10.0 mm in largest basal diameter (LBD). Snellen visual acuities were converted to logMAR for analysis. Visual acuity outcomes were analyzed in patients with an initial acuity of logMAR 0.7 or better (equivalent to Snellen 20/100). Rates of visual acuity loss and mortality were calculated using the Kaplan-Meier method. Acuity loss by tumor location was compared using log-rank testing. Rates of tumor recurrence, neovascular glaucoma (NVG), and eye loss were also described. <b><i>Results:</i></b> Two hundred and 22 patients were included in the study. The median age was 60.7 years (range 21.3–94.8 years). Median tumor thickness was 2.0 mm (range 1.2–2.5 mm), and median LBD was 8.0 mm (range 4.0–10.0 mm). Median follow-up was 6.9 years (range 1.0–30.2 years). In 204 patients with a baseline logMAR visual acuity of 0.7 or better, the mean baseline acuity was 0.15 (equivalent to Snellen 20/25), which decreased to 0.52 (approximately Snellen 20/70) by 5 years after PBI. Visual outcomes were significantly worse for patients with tumors located within 3 mm of the optic disc and/or fovea. Tumor recurrence (1.4%), NVG (4.5%), and eye loss (2.7%) were uncommon. <b><i>Discussion:</i></b> Despite the advantageous dose distribution of protons, over half of patients with small choroidal melanomas located near the optic disc or fovea had a visual acuity equivalent to 20/80 or worse at 5 years after PBI. Treatment with AU-011 may allow better vision preservation in small tumors that carry a high risk of vision loss with radiotherapy.","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135109427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Optic nerve (ON) enhancement alone without ON thickening on contrast-enhanced magnetic resonance imaging (CE-MRI) can be associated with post-laminar optic nerve invasion (PLONI) in eyes with group E retinoblastoma. A few case reports and retrospective studies in the literature show a poor correlation between ON enhancement on MRI and ON invasion on histopathological examination (HPE). There is no universal consensus on the management of such cases. It is desirable that the presence and extent of a true ON invasion be reliably picked up before planning upfront enucleation in order to avoid stage II disease.
Methods: In a prospective study conducted at a tertiary eye care center in North India, all retinoblastoma patients presenting with ON enhancement on imaging were evaluated. Demographic and imaging details, histopathological findings, and treatment details were recorded. The length and pattern of enhancement noted on MRI were correlated with histopathology. Follow-up was done till the end of the study period.
Results: Six group E retinoblastoma eyes were evaluated. 3 eyes (50%) showed solid enhancement, 2 eyes (33.33%) had tram track pattern and 1 eye (16.66%) showed punctate enhancement pattern on CE-MRI. On histopathology, 5 (83.33%) cases showed PLONI and all 6 (100%) had ON head infiltration. The cut end of the ON was free in all cases. On correlating MRI and HPE, all eyes with solid enhancement pattern showed PLONI, of which 2/3 (66.6%) had diffuse ON infiltration. Only 50% of eyes with tram track patterns showed PLONI. The case which showed a punctate enhancement pattern showed focal infiltration by tumor cells with vacuolated cytoplasm on HPE. At the last follow-up, all patients were alive and free of disease.
Conclusion: ON enhancement patterns may make it more predictive for PLONI on HPE. Solid enhancement pattern appears to correlate better with the extent of ON invasion on HPE, and longer lengths of solid ON enhancement may be considered for neoadjuvant chemotherapy rather than upfront enucleation.
{"title":"Can Enhancement Pattern in Normal-Sized Optic Nerves on Magnetic Resonance Imaging Better Predict Tumor Invasion in Retinoblastoma Eyes?","authors":"Madhu Chiranthan, Rachna Meel, Sanjay Sharma, Neiwete Lomi, Seema Kashyap, Mandeep S Bajaj","doi":"10.1159/000531354","DOIUrl":"https://doi.org/10.1159/000531354","url":null,"abstract":"<p><strong>Introduction: </strong>Optic nerve (ON) enhancement alone without ON thickening on contrast-enhanced magnetic resonance imaging (CE-MRI) can be associated with post-laminar optic nerve invasion (PLONI) in eyes with group E retinoblastoma. A few case reports and retrospective studies in the literature show a poor correlation between ON enhancement on MRI and ON invasion on histopathological examination (HPE). There is no universal consensus on the management of such cases. It is desirable that the presence and extent of a true ON invasion be reliably picked up before planning upfront enucleation in order to avoid stage II disease.</p><p><strong>Methods: </strong>In a prospective study conducted at a tertiary eye care center in North India, all retinoblastoma patients presenting with ON enhancement on imaging were evaluated. Demographic and imaging details, histopathological findings, and treatment details were recorded. The length and pattern of enhancement noted on MRI were correlated with histopathology. Follow-up was done till the end of the study period.</p><p><strong>Results: </strong>Six group E retinoblastoma eyes were evaluated. 3 eyes (50%) showed solid enhancement, 2 eyes (33.33%) had tram track pattern and 1 eye (16.66%) showed punctate enhancement pattern on CE-MRI. On histopathology, 5 (83.33%) cases showed PLONI and all 6 (100%) had ON head infiltration. The cut end of the ON was free in all cases. On correlating MRI and HPE, all eyes with solid enhancement pattern showed PLONI, of which 2/3 (66.6%) had diffuse ON infiltration. Only 50% of eyes with tram track patterns showed PLONI. The case which showed a punctate enhancement pattern showed focal infiltration by tumor cells with vacuolated cytoplasm on HPE. At the last follow-up, all patients were alive and free of disease.</p><p><strong>Conclusion: </strong>ON enhancement patterns may make it more predictive for PLONI on HPE. Solid enhancement pattern appears to correlate better with the extent of ON invasion on HPE, and longer lengths of solid ON enhancement may be considered for neoadjuvant chemotherapy rather than upfront enucleation.</p>","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"9 3-4","pages":"107-114"},"PeriodicalIF":1.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71413342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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