Histopathology-guided management of ocular surface squamous neoplasia with corneal stromal or scleral invasion using ruthenium-106 plaque brachytherapy.

BACKGROUND/AIM: To evaluate the safety and efficacy of ruthenium-106 (Ru-106) plaque brachytherapy in managing invasive ocular surface squamous neoplasia (OSSN). METHODS: This is a retrospective, non-comparative, interventional case series of 42 eyes with OSSN with histopathologically-proven corneal stromal and/or scleral invasion that underwent Ru-106 plaque brachytherapy. Main outcome measures were tumour regression, eye salvage, final visual acuity, treatment complications and metastasis. RESULTS: At presentation, the mean tumour basal diameter was 9.3 mm (range 5-26 mm) and thickness 3.1 mm (range 1.5-11 mm). Prior treatment included excision biopsy in two patients (5%), incision biopsy and topical interferon in one each (2%). Following excision with 4 mm clinically clear margins, corneal stromal and/or scleral invasion of OSSN was confirmed in all 42 cases, with the excised base showing invasive squamous cell carcinoma. A total dose of 5000 cGy over a mean duration of 19.7 hours (range 7-41 hours) was provided to an axial depth of 2 mm using Ru-106 surface plaque. Over a mean follow-up of 36.9 months (range 22.3-72 months), complete tumour regression was achieved in all eyes (100%). Two eyes (5%) showed conjunctival tumour growth remote from the site of prior treatment. Visual acuity was maintained at ≥20/200 in 35 eyes (83%), with a loss of >2 Snellen lines in 1 eye (2%). There was no evidence of regional lymph node or systemic metastasis. CONCLUSION: Histopathology-guided use of Ru-106 surface plaque brachytherapy is a safe and an effective adjuvant therapy in the management of corneal stromal and/or scleral invasion of OSSN.

Vogt-Koyanagi-Harada disease during prolonged intermittent steroid therapy for chronic obstructive pulmonary disease: a case report.

Vogt-Koyanagi-Harada Disease (VKHD) is a rare systemic granulomatous autoimmune condition that affects melanocyte-rich organs including the eyes, inner ears, meninges, skin, and hair. VKHD causes chronic uveal inflammation and a loss in visual acuity in some patients. Patients generally respond well to steroid therapy. In our patient, we evidenced VKHD in the chronic recurrent stage at the time of presentation while the patient was on intermittent systemic steroid therapy. To date, no cases of VKHD have been reported in patients who were taking immunosuppressive medications. This study sheds light on the possibility that, in addition to the complex multisystem autoimmune phenomenon, other variable factors may also be implicated in the etiopathogenesis of this disease. Also, if a patient presents with subacute vision loss and an acute onset headache and encephalopathy, this differential diagnosis should be kept in mind, and the patient should be treated as soon as possible if the diagnosis is confirmed.

Mucor in a Viral Land: A Tale of Two Pathogens.

Purpose: COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment. Methods: We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue. Results: All patients were male, mean age 60.5 ± 12 (46.2-73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86-404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3-42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy. Conclusion: Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival.

Uveoscleral metastasis in laryngeal carcinoma.

Ocular metastatic lesions from head to neck region are rare. 55 years old male patient presented with loss of vision, pain, and proptosis of the left eye. The patient was known case of laryngeal squamous carcinoma underwent laryngectomy 1 and half years back followed by chemoradiation. Well-defined scleral nodule extending from limbus to optic nerve was noted. In view of no other metastatic focus other than left eye on positron emission tomography (PET) scan, left eye enucleation was performed. Histopathological examination (HPE) showed squamous cell carcinoma. The patient received external beam radiotherapy (EBRT) for left eye orbit. This is the first well-documented proven case of uveoscleral metastasis from laryngeal carcinoma.

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid: Clinicopathologic features, immunohistochemical findings and review of literature.

Sweat gland neoplasms are rare adnexal tumors that pose a diagnostic challenge for both, ophthalmologists and pathologists. Endocrine, mucin producing sweat gland carcinoma (EMPSGC), considered to be analogous to the solid papillary mammary carcinoma is one such tumor. It usually affects elderly, is more frequent in women and has a predilection for skin of the eyelid. Although it has an indolent clinical course, EMPSGC is believed to be a precursor of the invasive mucinous carcinoma and has a potential for local recurrence. We report a series of 10 biopsy-proven EMPSGCs with their immunohistochemical features and review the literature.

An unusual occurrence of stromal keratitis in dengue fever.

Dengue is a mosquito-borne infection endemic in the tropical and subtropical regions of the world. Classic dengue fever is a self-limiting, influenza-like illness transmitted by Aedes aegypti mosquito. Ophthalmic manifestations though rare can involve both the anterior and posterior segments and are usually associated with the thrombocytopenic state. However, ophthalmic complications such as anterior uveitis and vasculitis suggest immune-mediated pathogenesis. Herein, we report a rare case of stromal keratitis and an unusual occurrence of simultaneous bilateral blindness following dengue fever in a young girl.

A Prospective Study to Compare Visual Outcomes Between Wavefront-optimized and Topography-guided Ablation Profiles in Contralateral Eyes With Myopia.

PURPOSE: To analyze refractive outcomes of wavefront-optimized (WFO) ablation and topography-guided custom ablation (TCAT) profiles using the Allegretto Wave excimer laser platform (Alcon Laboratories, Inc., Fort Worth, TX) in the treatment of myopia. METHODS: Sixty eyes of 30 patients who underwent LASIK were included in this prospective interventional study. WFO ablation was performed in one eye (WFO group) and TCAT in the fellow eye (TCAT group). The WaveLight FS200 femtosecond laser (Alcon Laboratories, Inc.) was used to create the flap and Allegretto Wave excimer laser (Alcon Laboratories, Inc.) was used for photoablation. The Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany) and Allegretto Topolyzer (Alcon Laboratories, Inc.) were used to measure the corneal aberrations. Refractive visual outcomes were also compared. RESULTS: Accuracy, safety, and efficacy were similar in the two groups. The total root mean square (RMS) and RMS of lower order aberrations were significantly better in eyes that underwent TCAT (P < .05). There was a decrease in individual higher order aberrations in the TCAT group, with a statistically significant difference in the spherical aberrations (P = .02). The corneal asphericity (Q value) was not significantly different between the WFO (0.6 ± 0.1) and TCAT (0.51 ± 0.09) groups. The postoperative total RMS of higher order aberrations was lower in the TCAT group, but this was not statistically significant (P > .05). There was a more positive change in Q value and spherical aberrations in the WFO group, but this was not statistically significant. CONCLUSIONS: TCAT and WFO ablation provided essentially equivalent outcomes after myopic LASIK, with induction of fewer lower order aberrations and higher order aberrations following TCAT ablation. [J Refract Surg. 2017;33(1):6-10.].