Progressive Necrotizing Ocular Surface Disease, Despite Immunosuppression.

A 60-year-old man was referred with 2 years of left conjunctivitis that persisted despite antibiotic and systemic corticosteroid therapy. The severity and extent of surface disease had increased slowly after prior dacryocystorhinostomy. Subsequent conjunctival biopsies demonstrated granulomas with patchy necrosis but no evidence of malignancy or organisms; systemic screening for sarcoidosis and tuberculosis was negative. A markedly thickened and inflamed left ocular surface was present on referral, with areas of conjunctival ischemia and patchy white slough on the tarsi. Further ocular surface biopsy did not reveal malignancy, and therefore mycobacterial infection was considered a possible cause. Mycobacterium tuberculosis was cultured, albeit only after repeated conjunctival swabs and biopsies. Appropriate treatment led to a very rapid resolution of ocular surface disease. Localized periocular tuberculosis is extremely rare outside developing nations, and its rarity may cause this differential diagnosis for persistent severe ocular surface disease to be overlooked in industrialized nations.

Large orbital masses due to longstanding hydrogel retinal explants.

AIM: To describe the features of orbital masses occurring as a late complication of hydrogel retinal explants. PATIENTS AND METHODS: Retrospective review of patients presenting with orbital masses at decades after retinal surgery. RESULTS: Two patients with huge orbital masses are described, their presenting 25 and 28 years after retinal detachment repair with expansile hydrogel explants. In one case, the preoperative diagnosis was pleomorphic adenoma, and the other-with extreme distortion of the globe-was considered to be lymphoma or chronic inflammation arising around prior retinal explants. At orbitotomy, the masses were found to be grossly expanded hydrogel explants that were removed piecemeal from their fibrous capsules. Histopathology showed very mild inflammation with occasional multinucleate giant cells and patchy capsular calcification, and an eosinophilic amorphous material staining strongly with Alcian-blue. Surgery was uncomplicated and both orbits healed with marked functional improvement. CONCLUSION: Expansile hydrogel retinal explants were largely used in the 1980s and can present, often decades after the retinal surgery, with impaired orbital functions due to large parabulbar masses. The hydrophilic material appears to expand very slowly over decades, leading to gross distortion of neighbouring structures and a tumour-like mass.

A novel KRAS mutation in metastasic conjunctival melanoma: a case report and literature review.

Conjunctival melanoma is a rare disease, and little is known about its molecular background. Here, we present the case of a 48-year-old patient with conjunctival melanoma and metachronic lymph node and skin metastasis with KRAS p.K117Y mutation in exon 4 in all the lesions. The cancer genome interpreter predicted this mutation to have driver function. To our knowledge, this is the first time this mutation is found in conjunctival melanoma. An important role in the disease development is suggested.