Effects of posterior staphyloma on choroidal structure in myopic adults: a retrospective study.

BACKGROUND: Studies on the choroid of myopic eyes with posterior staphyloma have shown that choroidal thickness decreased. This retrospective study further analysed the effects of posterior scleral staphyloma on choroidal blood vessels and matrix components compared to non-pathological myopia. METHODS: In this cross-sectional study, ninety-one eyes were divided into pathological (posterior staphyloma) and non-pathological myopia. The latter was further divided into three groups (Group 1: 26 mm ≤ axial length; Group 2: 24 mm ≤ axial length < 26 mm; Group 3: 22 mm ≤ axial length < 24 mm). Choroidal thickness, total choroidal area, luminal area, stromal area, and choroidal vascularity index were calculated. RESULTS: The CVI in N1, N2, I1, S2 of the posterior staphyloma group were lower than those of group 1 (both P < 0.05). The mean height of posterior staphyloma was associated with mean CT (Pearson correlation: r = -0.578, P = 0.039) but not with the mean CVI in posterior staphyloma group. In all groups, the mean choroidal thickness, total choroidal area, luminal area, and stromal area were significantly associated with axial length (P < 0.001), and the mean choroidal vascularity index was significantly associated with the mean choroidal thickness (P < 0.001). CONCLUSION: The choroidal structure of pathological myopia with posterior staphyloma and non-pathological myopia with longer axial length demonstrates alterations in which choroidal vessels are more impaired than the stroma. A lower choroidal vascularity index should be alert to pathological changes for myopia with axial length > 26 mm.

A physical sign of pathological myopia: myopic scleral pit.

PURPOSE: Myopic scleral pit (MSP) is a rare physical sign of pathological myopia (PM). The aim of this study was to summarize the clinical characteristics of MSP and analyze its correlation with PM. METHODS: Eight cases with PM and MSP were enrolled in this study. Comprehensive ophthalmic examinations, including subjective refraction, slit-lamp biomicroscope, intraocular pressure, fundus photographs, A- and B-scan ultrasonography and spectral-domain optical coherence tomography, were performed. RESULTS: All the patients had a long history of PM with visual impairment, long axial length, and myopia-related fundus degeneration. Mean axial length was 31.48 ± 2.17 mm. Mean size of MSP was 0.69 ± 0.29 optic disc diameter (PD). Mean logMAR BCVA was 1.21 ± 0.88 logMAR. Spearman correlation analysis showed that the logMAR BCVA had no correlation with the size of pits (P = 0.34). Fundus examination revealed a focal pale concave located in the sclera exposed area of retinal choroid atrophy was found in all cases. OCT showed a deep scleral pit where the retinal choroid was thin or absent, without retinal sensory detachment or sensory defect. CONCLUSIONS: This study identified a rare scleral lesion in all eight individuals with PM, which was termed "myopic scleral pit". This phenomenon is different from focal choroidal excavation and posterior staphyloma.

[Advances on optic disc morphological features and peripapillary structure changes in high myopia].

High myopia is an important cause of low vision and blindness in the world, most of which are characterized by the prolongation of the axial length, accompanied by various degenerative changes of fundus posterior pole, especially in the optic disc area and peripapillary structures, such as optic disc tilt, optic cup and rim changes, chorioretinal atrophy, posterior staphyloma and intrachoroidal cavitation, and so on. This article reviews the optic disc morphological features and peripapillary structure changes of high myopia, in order to reveal the pathogenesis of high myopia and provide new ideas for finding more effective prevention and treatment methods.

A 10-year review of histopathological findings of enucleated eyes from a tertiary-care center, Pakistan.

OBJECTIVE: To determine the histopathology of enucleated eye specimens. METHODS: The 10-year inventory was conducted at Aga Khan University Hospital, Karachi, and comprised all histopathology reports of enucleated eye specimens received from January 2007 to December 2016 by the Section of Histopathology, Department of Pathology. SPSS 19 was used for data analysis. RESULTS: A total of 232 ocular tissue specimens from 231 patients were evaluated. Ocular tumours were the most common histopathological diagnosis 186(80%). Among tumours, retinoblastoma was the most common 137(59%) followed by malignant melanoma 31(13%) and squamous cell carcinoma 15(6.5%). Overall, 16(6.9%) specimens had degenerative changes secondary to different ocular disorders. Staphyloma and Coat's disease was diagnosed in 3(1.3%) cases each. In 4(1.7%) cases, there was no formal diagnosis. CONCLUSIONS: Early identification of tumours may allow for conservative management and limit the need for enucleations.

Reaction on "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma".

BACKGROUND: In the recently published article entitled "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma" Jacobsen et al. describe a case in which a hyper-intense extra-ocular lesion on MRI was erroneously diagnosed as an extrascleral extension of the tumor. Based upon this the authors conclude "the superiority of ocular ultrasound in the diagnostic management of extra scleral extension in choroidal melanoma". In our view, there are numerous flaws in the investigation that cast doubt on this message. MAIN: First of all, this is quite a bold statement when only one patient has been evaluated. Secondly, the manuscript only presents a post-contrast T1-weighted image, whereas multiple MRI-sequences need to be included to determine if a hyperintense region is an extrascleral invasion. Moreover, no modern MRI-techniques such Dynamic Contrast Enhanced (DCE) or Diffusion Weighted Imaging (DWI) have been included in the evaluation of this patient, making it hard to use this single case to compare the efficacy of MRI and Ultrasound. The presented data do, however, give clear clues that the hyperintense lesion is likely to be inflammatory. CONCLUSION: Although the study falls short in providing a comprehensive comparison between current MRI techniques and ultrasound, it does show that the evaluation of ocular MR-images should be made in a multi-disciplinary setting involving both ophthalmologist and radiologists, since the field of ocular MRI is continuously progressing.

[Relation between ultrasonographic characteristics of pathologic myopia posterior staphyloma and retinoschisis].

Objective: To study the ultrasonographic characteristics of pathologic myopia posterior staphyloma and the relation with retinoschisis. Methods: Retrospective case series study. Eighty-seven eyes of 66 pathologic myopia patients with posterior staphyloma were included. Staphyloma morphology and anteroposterior axis of the eyeball were observed by B-scan ultrasonography. Optical coherence tomography was used to explore the retinoschisis. Results: Arc-shaped (10.35%), cone-shaped (22.99%), wedge-shaped (33.33%) and rectangle-shaped (33.33%) posterior staphylomas were found by B-scan ultrasonography. Posterior pole or macular retinoschisis was found by optical coherence tomography in 65 eyes (74.71%), 56 of which (86.15%) were observed to have a rough posterior ocular wall or membranoid attachment by ultrasonography. The anteroposterior axis of arc-shaped posterior staphyloma was shorter than that of staphylomas in the other shapes. Posterior staphyloma morphology was related to retinoschisis(r=0.385, 0.406. P<0.01). The retinoschisis was at the macula in 80.00% of cone-shaped posterior staphyloma, at the wedge-shaped corner in 75.00% of wedge-shaped posterior staphyloma and at the rectangle-shaped corner in 62.50% of rectangle-shaped posterior staphyloma. Conclusions: It is hard to discover retinoschisis of pathologic myopia posterior staphyloma by ophthalmoscopy. Morphologic characters of posterior staphyloma and conditions of posterior eyewall can be showed directly under ultrasonographic examination. B-scan ultrasonography may provide a diagnostic basis for pathologic myopia retinoschisis. (Chin J Ophthalmol, 2017, 53: 46-52).

[Characteristics of retinal and scleral infiltration in uveal melanoma].

Objective: To analyze features of retinal and scleral infiltration of uveal melanoma. Methods: It was a retrospective case series study. The pathological and clinical data of 102 cases of uveal melanoma were analyzed retrospectively, which were collected between Jun. 2001 and Apr. 2013 in Beijing Tongren Hospital, Capital Medical University. The tumor shape, size, cell types, retinal and scleral invasion were recorded and analyzed. The relationship between retinal invasion and scleral invasion was analyzed by trend Chi-square test. Results: There were 44 male patients and 58 female patients with an average age of 45.6±12.4 (range from 15 to 78 years old) in 102 cases. As for tumor size, there were 68 (66.7%) large size tumors, 27 (26.5%) medium size tumors and 7(6.8%) small size tumors; As for cell types, 76 (74.5%) were spindle cell, 6 (5.9%) were epithelioid cell, 16 (15.7%) were mixed cell, and 4 (4.0%) were others; As for tumor location, there were 3 (2.94%) ciliary body melanoma, 28 (27.5%) ciliary body and anterior choroid melanoma, and 71 (69.6%) choroid melanoma. Eighty-six cases (84.3%) showed retinal invasion, in which there were 20 cases of outer nuclear layer invasion (19.6%), 12 cases of inner nuclear layer invasion (11.8%), 30 cases of ganglion cell layer invasion (29.4%), and 24 cases of inner limiting membrane invasion (23.5%). Fifty-five cases (53.9%) showed scleral invasions, in which there were 11 cases (68.8%) of no retinal invasion, 13 cases of outer nuclear layer invasion (65.0%), 5 cases of inner nuclear layer invasion (41.7%), 15 cases of ganglion cell layer invasion (50.0%) and 11 cases of inner limiting membrane invasion (45.8%). In 76 spindle cell cases, the scleral invasion rate of different retinal invasion degree were 72.7% in 8 cases of none retinal invasion, 71.4% in 10 cases of outer nuclear layer invasion, 62.5% in 5 cases of inner nuclear layer invasion, 53.9% in 14 cases of ganglion cell layer invasion and 47.1% in 8 cases of inner limiting membrane invasion. No significant relationship was found between retinal and scleral invasion (γ=-0.21, P=0.127) . Conclusion: With the increase of scleral invasion, the retinal invasion decreased. However, the correlation show no statistical significance.(Chin J Ophthalmol, 2016, 52: 749-754).

[Clinical and pathologic observation of uveal metastatic carcinoma].

Objective: To observe the clinical and pathological features of uveal metastatic carcinoma. Methods: It was a retrospective case series study. The clinical manifestation, growth pattern, tumor types and relative pathological features of 13 patients visiting from January 1980 to December 2014 with uveal metastatic carcinoma in Tianjin Eye Hospital were analyzed retrospectively. Results: There were 13 cases, 6 cases of male and 7 of female. Age was from 37.0 to 66.0 years old. The mean age was 52.1 years old. all cases were monocular. There were 5 cases with right eye and 8 cases with left eye. Among 13 cases, 10 tumors were in posterior choroid, one tumor was in anterior choroid and ciliary body, 2 tumors were in the iris. There were 5 patients with lung cancer, 4 patients with breast cancer, 1 patient with prostate cancer, 1 patient with thyroid cancer and 1 patient with esophageal cancer. The primary tumor wasn't found in 1 patient. The rapid decrease of visual acuity showed in 10 patients with posterior choroidal metastatic carcinoma, 8 of them accompanied with extensive retinal detachment and 6 of them had secondary glaucoma. The multiple gray-white nodule or pink cauliflower mass on the papillary margin of iris were showed respectively in 2 patients with iris metastatic carcinoma. The pathological examination found that posterior choroidal metastatic carcinoma mainly located in temporal or nasal side choroids in 10 cases, among them, local or diffuse flat choroidal masses showed in 6cases, extensive mass involving choroid and ciliary body showed in 1 case, large nodular or globular choroidal mass showed in 2 cases, choroidal mass surrounded the optic disc in 1 case, optic nerve invasion showed in 3 cases and extraocular or orbital invasion showed in 3 cases. The scleral and subconjunctival invasion showed in 1 case of anterior choroid and ciliary body metastatic carcinoma. Conclusions: Uveal metastatic carcinoma manifested various growth pattern, the rapid decrease of visual acuity, flat or nodular choroidal solid mass, secondary retinal detachment and glaucoma were common clinical features. Some cases might invade extraocular or orbital tissue. (Chin J Ophthalmol, 2016, 52: 769-774).

Ocular Surface Squamous Neoplasia in 200 Patients: A Case-Control Study of Immunosuppression Resulting from Human Immunodeficiency Virus versus Immunocompetency.

PURPOSE: To describe and compare the clinical presentation, treatment outcomes, and histopathologic features of ocular surface squamous neoplasia (OSSN) based on human immunodeficiency virus (HIV) status. DESIGN: Case-control study. PARTICIPANTS: A total of 200 patients with OSSN, of whom 83 (41%) had positive results for HIV and were classified as cases and 117 (59%) had negative results for HIV and were classified as controls. METHODS: Enzyme-linked immunosorbent assay for HIV, conjuntival excision biopsy, extended enucleation, orbital exenteration. MAIN OUTCOME MEASURES: Clinical features, treatment outcomes, and histopathologic characteristics. RESULTS: The mean age at presentation of OSSN in both cases and controls was 40 years (median, 40 years; range, 13-65 years) and in controls was 40 years (median, 38 years; range, 15-80 years). On comparison of cases versus controls with OSSN, HIV-positive individuals had larger (12 vs. 8 mm; P < 0.001) and thicker (3.2 vs. 2.3 mm; P = 0.041) tumors, with a higher incidence of corneal (60% vs. 40%; P = 0.007), scleral (19% vs. 9%; P = 0.044), and orbital (13% vs. 3%; P = 0.019) invasion and a higher need for extended enucleation or exenteration (27% vs. 11%; P < 0.001). The bilateral presentation (11% vs. 4%; P = 0.13), need for lamellar sclerectomy (13% vs. 8%; P = 0.29), and tumor recurrence after primary treatment (30% vs. 20%; P = 0.12) was higher in HIV-positive cases compared with HIV-negative controls. However, these features were not statistically significant. Based on American Joint Committee on Cancer classification, T1 tumor was more common in controls (13% in cases vs. 35% in controls; P = 0.0009), and T4 tumor was more common in cases (13% in cases vs. 4% in controls; P = 0.019). None of the patients demonstrated systemic metastases or died of disease during a mean follow-up period of 10 months (median, 4 months; range, <1-75 months) in cases and 9 months (median, 4 months; range, <1-99 months) in controls. CONCLUSIONS: Ocular surface squamous neoplasia in HIV-positive individuals is aggressive with larger and thicker tumors and with higher incidence of corneal, scleral, and orbital invasion. These patients are associated with poor ocular prognosis with higher need for extended enucleation, exenteration, or both.

Episcleral infantile hemangioma successfully treated with topical timolol.

Episcleral hemangiomas are usually associated with neonatal hemangiomatosis. Recently, propranolol has been described for the treatment of this entity. We present for the first time a patient with an episcleral hemangioma without neonatal hemangiomatosis successfully treated with topical timolol.

A case of epibulbar osseous choristoma with review of literature.

Epibulbar osseous choristomas are rare congenital simple choristomas consisting of pure bone on the sclera. It is usually recognized in childhood and most often located in the superotemporal quadrant. A case of 7-year-old male who presented with a history of mass in the left eye was reported in this paper. The mass had been present since birth but had showed slight enlargement during the last 6 months. Examination revealed a 7 × 5 mm reddish, hard, and mobile mass located in the superotemporal quadrant. Excisional biopsy was done. On histopathological examination, excised mass was found to be composed of mature bony trabeculae enclosing osteocytes, and diagnosis of epibulbar osseous choristoma was made.

Changes of axial length measured by IOL master during 2 years in eyes of adults with pathologic myopia.

OBJECTIVE: To examine the change of the axial length measured by IOL Master in adults with high myopia during a 2-year period. DESIGN: Open-label, consecutive, prospective longitudinal case series. METHODS: One hundred and eighty-five eyes of 185 consecutive patients with bilateral high myopia (myopia ≤ -6 diopters (D) or axial length ≥ 26.5 mm) were studied. The mean age of the patients was 48.4 ± 12.2 years, with a range of 22 to 84 years. The axial length, the anterior chamber depth, and the radius of curvature of the cornea were measured by IOL Master at the initial examination and at 2 years after the first visit. The significance of the changes in the axial length after the 2-year periods was determined. Multiple regression analyses were performed to identify the factors which were significantly associated with the increase of the axial length. RESULTS: The mean axial length increased significantly from 29.35 ± 1.80 mm to 29.48 ± 1.85 mm in 2 years, a mean increase of 0.13 mm with a range of -0.12 to 1.10 mm. The difference in the increase of the axial length between the patients with and without a posterior staphyloma was not significant. Among the possible explanatory factors, age, axial length, anterior chamber depth, the radius of curvature of the cornea, and intraocular pressure at the initial examination, the increase in the axial length was significantly and positively correlated with the axial length at the initial examination. CONCLUSIONS: The measurement by IOL Master in a large population of highly myopic patients clearly showed that the axial length continued to increase in a span of 2 years even in the 4th decade of life. The eyes with longer axial length showed a greater increase of axial length, suggesting the possibility that the more myopic eyes become more myopic with increasing age.

A modified ultrasound-guided surgical technique for the management of the uveal effusion syndrome in patients with normal axial length and scleral thickness.

PURPOSE: The purpose of this study was to describe a modified surgical technique for the management of the uveal effusion syndrome (UES). METHODS: A consecutive interventional case series of six eyes with UES is reported. The diagnosis of the UES was based on detailed ophthalmic examination, fluorescein angiography, B-scan ultrasonography, biometry, and magnetic resonance imaging. All eyes underwent an ultrasound-guided placement of the sclerostomies subjacent to the area of maximal choroidal swelling using a scleral punch without scleral flaps or vortex vein decompression. RESULTS: All patients were men with a mean age of 53 years. The mean postoperative follow-up was 16.25 months. Five eyes had normal axial lengths (22.54-23.05 mm) by ultrasound and normal sclera thickness on magnetic resonance imaging. One eye had a shorter axial length (21.65 mm) and mild scleral thickening on magnetic resonance imaging. All six eyes had anterior peripheral choroidal swelling. Three eyes had associated serous retinal detachment, and three eyes had acute appositional angles. After surgery, five eyes had total resolution of the peripheral choroidal swelling and retinal detachment or normalization of the angle. One eye had partial resolution of the retinal detachment. Of the three eyes with retinal detachment, two eyes experienced improvement in visual acuity after surgery. No complications were noted. CONCLUSION: This modified ultrasound-guided surgical technique for sclerostomy placement seems to be effective in the management of the UES, including eyes with normal axial length and scleral thickness, a subset of the UES that has been previously reported not to respond to surgery.

Scleral patch grafts in the management of uveal and ocular surface tumors.

OBJECTIVE: To evaluate the outcome of scleral patch grafts in a series of patients undergoing management for uveal and ocular surface tumors. DESIGN: Case series. PARTICIPANTS: Ten patients underwent scleral patch grafting. Five patients had uveal melanoma with extrascleral extension, 2 patients had scleromalacia secondary to plaque radiotherapy for uveal melanoma, 2 patients had suspicious uveoscleral nevi, and 1 patient had invasive conjunctival squamous cell carcinoma with scleral necrosis. METHODS: Retrospective, interventional, noncomparative chart review of patients undergoing treatment for ocular tumors followed by scleral grafts in a tertiary eye care center in the United States between September 2003 and January 2011. Sclera was reconstructed with allogenic scleral grafts. Clinical observations were performed after grafting. MAIN OUTCOME MEASURES: Structural integrity, appearance, and stability of the grafts. RESULTS: Ten patients were reviewed. All melanoma cases received plaque radiotherapy with palladium 103. The cases with nevi and squamous cell carcinoma underwent local resection with cryotherapy as primary treatment. In 8 cases, scleral grafting was performed as part of the initial surgery. In all of these cases, satisfactory anatomic and functional outcomes were achieved. In 2 cases with scleromalacia secondary to radiotherapy for uveal melanoma, grafts were placed several years after the initial treatment. In these 2 cases, one showed signs of graft retraction, whereas another showed graft thinning. No patients experienced graft infection, rejection, or tumor recurrence. CONCLUSIONS: In this series, scleral grafts were well accepted when placed as part of the primary tumor management despite synchronous radiotherapy, scleral resection, or cryotherapy. Grafting was less successful when performed as a late procedure for radiation-induced scleromalacia. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Giant Mongolian macules with bilateral ocular involvement: case report and review.

Dermal melanocytosis is characterized by the presence of spindle-shaped melanocytes in the dermis. The most common form is Mongolian spots. A 15-month-old girl from Azerbaijan had a systematized dark blue-gray hyperpigmentation on her shoulder, back and extremities. The hyperpigmentation was also found on both sclera and choroidal areas, without any other facial involvement. On histopathological examination, dense melanocytes were found on the intermediate and deep dermis. Her physical and mental development was normal. This association of blue macules and involvement of both sclerae does not represent a distinct entity and cannot be categorized as an example of nevus of Ota.

Silicone Oil Tamponade-Retina Contact in Highly Myopic Eyes With and Without Encircling Bands: A Computational Fluid Dynamics Study.

Purpose: To investigate the behavior of silicone oil (SiO) at a steady equilibrium and during saccades in pseudophakic highly myopic eyes with posterior staphyloma with and without an encircling band and compare it to behavior in emmetropic eyes. The SiO-retina contact area and shear stress were calculated by computational fluid dynamics. Methods: A numerical model of an emmetropic eye and a myopic eye with and without scleral band underwent a saccade of 50°/0.137 s. The vitreous chamber surface was divided into superior and inferior 180° sectors: lens, pre-equator, post-equator, and macula. SiO-retina contact was evaluated as a function of fill percentages between 80% and 90% for standing, 45° upward tilt, and supine patients. Maximum and average shear stress were calculated. Results: Overall, SiO-retina contact ranged between 40% and 83%; fill percentage varied between 80% and 95%. Neither the encircling scleral band nor the staphyloma significantly affected the SiO-retina contact area, although the presence of a scleral band proved disadvantageous when gazing 45° upward. The inferior retina-SiO contact remained below 40% despite 95% SiO fill. The SS significantly increased at the scleral band indentation and decreased elsewhere. The staphyloma greatly reduced shear stress at the macula. Conclusions: The presence of a myopic staphyloma reduces shear stress at the macula but does not alter SiO-retina contact significantly. The apposition of a 360° scleral band may reduce SiO-retina contact at least in some postures and increases the SS at the indentation. Translational Relevance: Assessing SiO-retina contact when vitreous chamber geometry changes according to pathologic or iatrogenic modifications allows accurate prediction of real-life tamponade behavior and helps explain surgical outcomes.

Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis.

PURPOSE: To describe the histopathological characteristics of limbal stem cell deficiency (LSCD) due to chronic vernal keratoconjunctivitis (VKC). METHODS: This retrospective study included 14 eyes of 13 patients who underwent simple limbal epithelial transplantation for total LSCD from 2017 to 2018. The histological characteristics of the excised fibrovascular pannus were compared between 2 groups of 7 eyes, each with LSCD due to VKC and chemical burns (CB). Histological characteristics and type of inflammation were studied using special stains and immunohistochemistry. Fisher exact test was used to detect the statistical significance of the histological differences between both groups. RESULTS: Epithelial hypertrophy, epithelial downgrowth, and eosinophilic infiltration were noted in all eyes in the VKC group (7/7, 100%). Epithelial hypertrophy was noted in 3 of the 7 (42.8%) eyes in the CB group, whereas epithelial downgrowth and eosinophilic infiltrates were absent. The average chronic inflammatory score of the pannus (5.28) was higher in VKC than in CB (3.85; P = 0.1080). The presence of goblet cells was higher in the CB group (5/7, 1.4%) than in the VKC group (3/4, 2.8%), although not statistically significant. Other histological differences between the groups were not statistically significant. CONCLUSIONS: The histopathological features of LSCD in VKC reveal some distinctive characteristics. These include the presence of epithelial downgrowth, eosinophilic infiltration, and epithelial solid and cystic implants. Although this information may be used to establish the diagnostic criteria for VKC as the cause of LSCD, further studies are needed to elucidate the reasons behind these unique findings.