Primary Treatment of Eyelid Conjunctival Melanoma with Immunotherapy: A Case Report.

Conjunctival melanoma is a rare, life- and sight-threatening ocular malignancy sharing molecular features with cutaneous and mucosal melanoma. Despite current clinical approaches, high recurrence rates and frequent metastases pose significant challenges in management. Immune checkpoint inhibitors such as ipilimumab and nivolumab have revolutionized cutaneous melanoma treatment, but their efficacy in conjunctival melanoma remains largely unexplored. Herein, the authors present the case of metastatic palpebral conjunctival melanoma in a 59-year-old male successfully treated with a first-line combination of ipilimumab and nivolumab without adjuvant therapies or local surgeries. Local disease resolution was achieved after only 7 months of treatment, and the immune checkpoint inhibitor regimen was well-tolerated with limited systemic adverse effects and no ocular side effects.

Venous Thromboembolism and Bleeding Events With Chemoprophylaxis in Abdominoplasty: A Systematic Review and Pooled Analysis of 1596 Patients.

BACKGROUND: Many plastic surgeons avoid the administration of venous thromboembolism (VTE) chemoprophylaxis out of concern for surgical bleeding in abdominoplasty. Although previous studies have attempted to address the relationship between abdominoplasty and bleeding or VTE, poor reporting techniques remain a challenge. As a result, there has been a lack of reliable data to guide clinical practice. OBJECTIVES: The authors sought to determine the prevalence of bleeding and VTE in abdominoplasty with and without chemoprophylaxis. METHODS: A systematic review was performed following PRISMA guidelines utilizing PubMed, CINAHL, and Cochrane Central. Patient demographics, comorbidities, risk category (if available), bleeding events, VTE events, and chemoprophylaxis information were recorded. RESULTS: Across 10 articles, 691 patients received chemoprophylaxis in the setting of abdominoplasty: 68 preoperatively, 588 postoperatively, and 35 received both; 905 patients did not receive chemoprophylaxis. A total of 96.8% of patients were female, 73% underwent concomitant liposuction, and none were clearly risk stratified. The overall incidence of VTE and bleeding was 0.56% (9/1596) and 1.6% (25/1596), respectively. Compared with no chemoprophylaxis, chemoprophylaxis was not associated with increased incidence of bleeding (1.3% [9/671] vs 0.91% [8/881], P = 0.417) or decreased incidence of VTE (0.87% [6/691] vs 0.33% [3/901], P = 0.187). CONCLUSIONS: The prevalence of bleeding in abdominoplasty was low. Chemoprophylaxis was not associated with increased risk of bleeding or decreased risk of VTE, though the lack of risk stratification and heterogeneity of the cohort precludes firm conclusions. This study underscores the importance of utilizing validated risk-stratification tools to guide perioperative decision-making.

Reduction in Ferritin Concentrations among Patients Consuming a Dark-Green Leafy Vegetable-Rich, Low Inflammatory Foods Everyday (LIFE) Diet.

Background: Ferritin is an iron-containing protein and acute-phase reactant, which may be elevated due to systemic iron overload or inflammation. Various diseases are associated with excess iron, but therapeutic iron chelation is suboptimal. Prior studies suggest that several plant phytochemicals possess iron-chelating properties, indicating that a plant-based diet may benefit patients with iron overload. Objectives: The aim was to investigate whether patients who consume a nutrient-dense, dark-green leafy vegetable-rich diet, called the Low Inflammatory Foods Everyday (LIFE) diet, experience reductions in ferritin concentrations. Methods: This was a retrospective study in which patients were intensively counseled to follow the LIFE diet. Compliance was assessed by patient interviews and serum B-carotene measurements. Primary outcomes included changes in ferritin, B-carotene, and C-reactive protein (CRP). Patients with elevated CRP concentrations at baseline were excluded in order to separate the impact of inflammation from iron overload on ferritin concentrations. Premenopausal women, who lose iron from menstruation, were also excluded. Results: Thirty-two patients met the inclusion criteria. The median follow-up was 183 d.   Following the dietary intervention, ferritin decreased (-81 µg/L, P = 0.006) and B-carotene increased (46 µg/L, P < 0.0001), whereas CRP remained unchanged (-0.02 mg/L, P = 0.86). Adherent patients had greater reductions in ferritin compared with nonadherent patients (-138 µg/L vs. 15 µg/L, P = 0.001). Among all patients, there was an inverse relation between B-carotene and ferritin (-2.02, P = 0.03). Conclusions: The LIFE diet, or similar dark-green leafy vegetable-rich, whole-food plant-based diets, may benefit patients with disorders of iron overload and iron-induced oxidative stress.

Local recurrence of uveal melanoma and concomitant brain metastases associated with an activating telomerase promoter mutation seven years after secondary enucleation.

Purpose: To describe a case of local recurrence of uveal melanoma with concomitant brain metastases after secondary enucleation. Observations: A 73 year-old patient presented with dizziness and gait instability. MRI of the orbits and brain showed an anophthalmic socket with an orbital implant and an associated optic nerve mass as well as multiple mass lesions in the brain. The patient's history was significant for secondary enucleation for uveal melanoma recurrence seven years prior to presentation. Histopathology of the enucleated eye revealed no signs of extrascleral extension or optic nerve invasion. Biopsy of the optic nerve mass confirmed recurrent uveal melanoma with somatic mutations in GNAQ (Q209L) and the telomerase (TERT) promoter (c.1-124C > T) found on targeted next-generation sequencing (NGS). The same mutations were found in the primary tumor in the patient's archived enucleation samples. Conclusions: Local recurrence of uveal melanoma can occur after enucleation and is associated with an increased risk of systemic metastases. It is important for clinicians to monitor patients for local recurrence and systemic metastases even after enucleation. Genetic biomarkers may play an important role in identifying tumors at highest risk of local recurrence and metastasis. To our knowledge, this is the first case study to describe the TERT promoter mutation c.1-124C > T in the setting of recurrent uveal melanoma.

Orbital Fractures and Risk Factors for Ocular Injury.

Purpose: To identify factors predictive of serious ocular injury requiring urgent consultation by ophthalmology in patients presenting with blunt trauma orbital fractures. Methods: This is a retrospective study of adult patients diagnosed with orbital fractures after blunt trauma at a university medical center emergency room. Patient records were examined over a three-year period. Data including mechanism of injury, fracture location, ocular symptoms, and examination findings were recorded. Ocular injuries were divided into three levels of severity: mild, moderate, and severe. Fracture characteristics, patient demographics, and examination findings were analyzed using multinomial regression to identify risk factors for more severe injury. Results: One hundred and eighty-six patients met inclusion criteria. For 29.6% of patients, urgent ophthalmologic consultation was required. Ruptured globes occurred in 2.2% of injuries. There was a statistically significant association between severe ocular injury and three examination findings: poor vision (OR 14.5; p < 0.001), afferent pupillary defect (OR 44.8; p < 0.001), and abnormal pupillary reaction (OR 28.0; p < 0.001). Likewise, blurry vision (OR 3.6; p = 0.018), ocular pain (OR 3.7; p = 0.011), and facial pain (OR 4.4; p = 0.031) were also associated with an increased risk of severe ocular injury. Abnormal pupillary reaction was associated with moderate injury (OR 4.5; p = 0.041). Demographic factors, mechanism of injury, anti-coagulant use, fracture location, diplopia, no documented vision, subconjunctival hemorrhage, chemosis, and motility restriction were not associated with injury severity. Conclusion: Most patients who presented to the emergency room with an orbital fracture did not require urgent ophthalmologic consultation. The presence of blurry vision, ocular pain, facial pain, poor vision, and afferent pupillary defect significantly increased the odds of severe injury. Abnormal pupillary reaction was associated with both moderate and severe injury.

An In-Depth Analysis of Research Output in Successful Integrated Plastic Surgery Match Applicants and Factors Associated With Matching at Top-Ranked Programs.

OBJECTIVE: With USMLE Step I score reports becoming pass/fail, research output may become a more important factor for applicants in the integrated plastic surgery match. The authors aim to assess the research output of successful applicants and bibliometric variables associated with matching at higher tier programs. DESIGN: A search of peer-reviewed publications up to or during September before the matriculant's match year was performed using PubMed, Google Scholar, and Scopus for each resident. Bibliometric variables were analyzed including those associated with matching at higher tier Doximity reputation/research programs. SETTING: University of Pennsylvania (Philadelphia, Pennsylvania). PARTICIPANTS: Integrated plastic surgery interns for the 2019 to 2020 and 2020 to 2021 academic years (n = 301). RESULTS: Three hundred one matriculants at 73 programs produced a total of 731 manuscripts. The mean number of publications and H-index per applicant was 2.43 ± 3.84 and 1.01 ± 1.30, respectively. The average and maximum journal impact factor was 2.8 ± 1.81 and 4.66 ± 5.59, respectively. H-index, total publications, plastic surgery-related and unrelated publications, and first-author studies were all associated with matching into both a higher ranked reputation and research tier program, respectively (p < 0.05). Highest impact factor publications were associated with matching at top tier research programs only (p < 0.05). Among students from US News Top 40 and non-Top 40 medical schools, total publications and first-author publications remained associated with matching at a higher tier reputation and research program (p < 0.05). However, plastic surgery-related publications were significantly linked to matching into a higher tier program for matriculants from non-Top 40 medical schools only (p < 0.05). CONCLUSIONS: Research productivity, particularly total publications and first-author publications, is associated with an increased likelihood of matching at a higher tier integrated plastic surgery residency. Regardless of their medical school's US News rank, students may gain a competitive edge in the match with increased research output.