Solitary adult orbital myofibroma: Report of a case and review of the literature.

PURPOSE: Myofibromas are benign soft tissue tumors commonly encountered in infancy and childhood. Developing usually within the first two years of life, they can be multicentric and involve deep visceral organs. OBSERVATIONS: We present the rare occurrence of a solitary orbital myofibroma in an adult patient. The clinical, histopathologic and immunohistochemical findings of the tumor are documented. CONCLUSIONS: A comprehensive review of pediatric and adult orbital and periocular involvement by myofibroma is presented. Its characteristic pathologic and molecular findings are reviewed. IMPORTANCE: Myofibromas are uncommon but important tumors that can occur in the head and neck region, including the orbit. Seen more often in children, they can rarely be encountered in adult patients. Diagnosis is possible with a panel of immunostains and molecular analysis can be further confirmatory.

Transcorneal Cryotherapy and Descemet Membrane Endothelial Keratoplasty to Treat Epithelial Downgrowth and Corneal Decompensation After Cataract Surgery.

PURPOSE: Epithelial downgrowth is a vision-threatening complication of intraocular surgery or penetrating ocular trauma, and although various therapeutic interventions have been performed to treat this disease, success has been limited. We present a case of corneal decompensation secondary to epithelial downgrowth after uncomplicated clear corneal cataract surgery in the left eye, treated successfully with sequential transcorneal cryotherapy to destroy epithelial cell nests followed by Descemet membrane endothelial keratoplasty (DMEK) to restore corneal clarity and vision. METHODS: We applied a transcorneal cryotherapy probe using a double freeze-thaw technique at -80°C to the entire cornea, with care taken to spare the limbus except at the superior temporal quadrant overlying the clear corneal incision where treatment was applied intentionally. The same procedure was performed 2 weeks later to ensure complete ablation of epithelial nest cells. Uncomplicated DMEK surgery using standard technique was performed 1 week later to restore corneal clarity. RESULTS: Visual acuity at presentation was 20/40. Endothelial cell densities were 2138 cells/mm (22% loss) and 1720 cells/mm (37% loss) at 3- and 12-months after DMEK, respectively. Two years after surgery, the best-corrected visual acuity remained 20/20 and the patient had no evidence of recurrence or limbal stem cell deficiency. CONCLUSIONS: The use of sequential cryotherapy as a targeted intervention to destroy invasive corneal epithelial cells followed by staged DMEK surgery to replace damaged corneal endothelium was, in this case, an effective treatment for endothelial decompensation secondary to epithelial downgrowth and may be a potential alternative for the management of this disease.

Evaluation of interferon alpha 2b as adjunctive therapy for conjunctival melanoma.

PURPOSE: Interferon alpha 2b (IFN-α2b) has been used as an adjunctive agent to treat conjunctival melanoma (CM), however its efficacy is unproved due to a paucity of data. We present 5 cases of incompletely excised CM lesions to inform clinical decision making regarding the adjunctive use of IFN-α2b. OBSERVATIONS: We identified all biopsy proven CM cases treated between 1997 and 2017 at the University of Iowa. Of these, we analyzed cases in which topical IFN-α2b drops were prescribed after the initial excision to treat surgical margins that were positive for primary acquired melanosis [PAM] with or without atypia or invasive CM. We noted the origin of CM (nevus, PAM, or de novo), presence and location of margins positive for residual melanoma, duration of IFN-α2b treatment, recurrences, time to recurrence, and outcome at last follow-up. Topical IFN-α2b drops (1 million IU/mL 4 times daily for 3-6 months) were used as adjunctive therapy in 5 cases following incomplete surgical excision of CM. The preceding lesion was PAM in 4 cases and compound nevus in 1 case. In 2 cases, margins were positive for PAM with atypia and both resulted in remission of melanoma at 54 and 33 months, respectively. However, in 3 cases, margins were positive for invasive melanoma and all 3 developed recurrence of melanoma despite IFN-α2b use. CONCLUSIONS AND IMPORTANCE: There are limited data regarding the efficacy of IFN-α2b as adjunctive therapy for incomplete excision of CM lesions. In this series, adjunctive topical IFN-α2b did not prevent recurrence in cases with surgical margins positive for invasive melanoma. Our results indicate that caution should be exercised when considering adjunctive IFN-α2b to treat CM lesions not excised completely.