Malignant Epiretinal Membrane After Proton Beam Radiation of Ciliary Body Melanoma.

Purpose: To report the development of malignant epiretinal membrane after radiation of ciliary body melanoma. Case Report: A 65-year-old woman was referred for evaluation of a ciliary body tumor in her right eye. On examination, a pigmented ciliary body tumor, displacing the iris anteriorly, was visible superotemporally and ultrasound biomicroscopy revealed a large solid ciliary body tumor. She was diagnosed with ciliary body melanoma and treated with proton beam radiation. Over the following 29 months, the treated tumor regressed but optical coherence tomography (OCT) showed the development of a dense epiretinal membrane. Enucleation was performed and histopathological examination showed viable melanoma cells in the vitreous cavity with sheet-like growth of viable spindle melanoma cells on the epiretinal surface. Conclusion: The development of a pigmented epiretinal membrane in eyes with uveal melanoma should raise the possibility of a malignant epiretinal membrane.

Treatment of Uveal Melanoma With Radioactive Iodine 125 Implant Compared With Proton Beam Radiotherapy.

OBJECTIVE: To review the current state of radiation therapy for uveal melanoma and compare particle radiation and brachytherapy. PATIENTS AND METHODS: The medical records of 156 patients treated for uveal melanoma between May 30, 2012, and March 16, 2020, were retrospectively reviewed. Treatments consisted of either radioactive iodine 125 implant (RAI) or fractionated proton radiation (proton beam therapy [PBT]). Baseline characteristics were compared using a Wilcoxon rank sum test or χ2 test. Outcomes were compared using Cox proportional hazards regression models or logistic regression models. RESULTS: The median length of follow-up after treatment was 2.7 years (range, 0.5 to 9.0 years). Patients who underwent treatment with RAI were older (median age, 67 vs 59 years; P<.001) and had a lower tumor classification (American Joint Commission on Cancer; P=.001) compared with those who underwent PBT. There was no significant difference between RAI and PBT in the outcomes of liver metastases, death, enucleation, tearing, vision loss, retinal detachment, tumor thickness, conjunctivitis, optic neuropathy, iris neovascularization, or neovascular glaucoma (all P>.05). Patients who underwent RAI treatment had significantly higher risk of diplopia (P<.001), cataract progression (P<.001), and maculopathy (P=.03) compared with those who received PBT. Patients who underwent RAI were at higher risk of eyelash loss (P=.006) compared with the PBT group. CONCLUSION: Treatment with PBT and RAI has similar efficacy; however, there are differences in the adverse outcomes associated with these 2 modalities.

Multiloculated Ciliary Body Cysts and Lenticular Coloboma: A Rare Phenotypic Variation Associated With Persistent Fetal Vasculature.

A case of a 4 year-old boy with persistent fetal vasculature, lenticular coloboma, and a benign, multiloculated ciliary body mass is reviewed. The presence of ciliary body cysts in association with persistent fetal vasculature is sparsely reported. Its presence in a child can cause a diagnostic dilemma and lead to amblyopia. [J Pediatr Ophthalmol Strabismus. 2018;55:e39-e41.].

Combined orbital proptosis and exudative retinal detachment as initial manifestations of acute myeloid leukemia.

We report bilateral orbital and choroidal involvement as the presenting sign of acute myeloid leukemia in a 2-year-old white girl. The patient presented with painless proptosis and subconjunctival hemorrhage. Ophthalmic examination and magnetic resonance imaging revealed bilateral leukemic infiltrates of the orbits and choroid, with an exudative retinal detachment in the right eye. Bone marrow biopsy confirmed acute myeloid leukemia. Following radiation treatment, chemotherapy, and hematopoietic stem cell transplantation, the patient was doing well 12 months after presentation. Outcomes can be poor, even with treatment; prompt recognition of ophthalmic manifestations of leukemia, including proptosis, choroidal infiltration, and retinal detachment, is necessary.

Nocardia brasiliensis endophthalmitis in a patient with an exposed Ahmed glaucoma drainage implant.

PURPOSE: To report a case of endophthalmitis due to Nocardia brasiliensis in an eye with an exposed, infected Ahmed glaucoma drainage implant (GDI). DESIGN: Retrospective case report. METHODS: A patient with an exposed GDI experienced recurrent episodes of endophthalmitis despite repeated intravitreal injections of antibiotics and steroids. The tube was initially repositioned and finally removed. RESULTS: Whereas repeated cultures from the anterior chamber and vitreous were negative, cultures from the removed tube grew Nocardia brasiliensis. Despite oral trimethoprim-sulfamethoxazole and intravitreal amikacin the eye became phthisical and lost light perception. CONCLUSIONS: An exposed GDI may lead to endophthalmitis due to Nocardia brasiliensis and may require explantation to establish a diagnosis.

A retrospective cohort study of clinical outcomes for intravitreal crystalline retained lens fragments after age-related cataract surgery: a comparison of same-day versus delayed vitrectomy.

BACKGROUND: This analysis compared outcomes for same-day (under a no-move, no-wait policy) versus delayed vitrectomy for intravitreal crystalline retained lens fragments after surgery for age-related cataract. METHODS: This was a retrospective, nonrandomized treatment comparison cohort study with a consecutive series of 35 eyes (23 same-day, 12 delayed) receiving both cataract surgery and vitrectomy at the Mayo Clinic Florida between 1999 and 2010. Outcome measures included visual acuity (VA), glaucoma progression, visual utility, and complications. Several techniques (bootstrapping, robust confidence intervals, jackknifing, and a homogeneous sample) were used to reduce selection bias and increase confidence in our small sample's results. RESULTS: No significant baseline treatment group differences. Mean previtrectomy delay (12 eyes) was 40.9 days (median 29.5, range 1-166). Mean postvitrectomy follow-up (35 eyes) was 47.5 months (median 40.5, range 3.1-123.5). Same-day patients had significantly better final VA (adjusted for age [t = -2.14, P = 0.040] and precataract surgery VA [t = -2.98, P = 0.006]); a higher rate of good final VA (≥20/40), 78.3% (18/23) versus 58.3% (7/12); a lower rate of bad final VA (≤20/200), 4.3% (1/23) versus 25.0% (3/12); and fewer final retinal conditions, 4.3% (1/23) versus 50.0% (6/12). Same-day patients also had marginally significant better mean final VA in the operated eye (20/40 versus 20/90, Z = 1.51, P = 0.130) despite poorer initial VA (20/98 versus 20/75) and higher age (3+ years), better final visual utility, and longer survival times for better VA. Among patients with preexisting glaucoma, same-day patients experienced significantly less differential (operated versus nonoperated eye) glaucoma progression. CONCLUSION: Results favored same-day patients, who experienced better final VA and visual utility, less differential glaucoma progression, and fewer complications. Results need confirmation with larger samples.

Outbreak of toxic anterior segment syndrome following cataract surgery associated with impurities in autoclave steam moisture.

BACKGROUND: Toxic anterior segment syndrome (TASS), a complication of cataract surgery, is a sterile inflammation of the anterior chamber of the eye. An outbreak of TASS was recognized at an outpatient surgical center and its affiliated hospital in December 2002. METHODS: Medical records of patients who underwent cataract surgery during the outbreak were reviewed, and surgical team members who participated in the operations were interviewed. Potential causes of TASS were identified and eliminated. Feedwater from autoclave steam generators and steam condensates were analyzed by use of spectroscopy and ion chromatography. RESULTS: During the outbreak, 8 (38%) of 21 cataract operations were complicated by TASS, compared with 2 (0.07%) of 2,713 operations performed from January 1996 through November 2002. Results of an initial investigation suggested that cataract surgical equipment may have been contaminated by suboptimal equipment reprocessing or as a result of personnel changes. The frequency of TASS decreased (1 of 44 cataract operations) after reassignment of personnel and revision of equipment reprocessing procedures. Further investigation identified the presence of impurities (eg, sulfates, copper, zinc, nickel, and silica) in autoclave steam moisture, which was attributed to improper maintenance of the autoclave steam generator in the outpatient surgical center. When impurities in autoclave steam moisture were eliminated, no cases of TASS were observed after more than 1,000 cataract operations. CONCLUSION: Suboptimal reprocessing of cataract surgical equipment may evolve over time in busy, multidisciplinary surgical centers. Clinically significant contamination of surgical equipment may result from inappropriate maintenance of steam sterilization systems. Standardization of protocols for reprocessing of cataract surgical equipment may prevent outbreaks of TASS and may be of assistance during outbreak investigations.

Vitrectomía a cielo abierto en el estadio cicatrizal grado V: desprendimiento de retina total con configuración en embudo cerrado / Open vitrectomy in cicatricial stage V: total retinal detachment with close funel configuration

Se efectuó vitrectomía a cielo abierto en 23 ojos de 18 niños (entre 4 y 35 meses de edad) que presentaban una Retinopatia del prematuro (R.P.) en etapa cicatrizal grado V - desprendimiento de retina total con configuración en embudo cerrado. Al finalizar el seguimiento, la retina estaba aplicada en el polo posterior en 8 ojos (8/23 = 34,7%). El seguimiento osciló entre 1 y 48 meses (media = 14 meses; mediana = 12 meses). Se analiza la posible influencia de factores clínico-patológicos y quirúrgicos en el resultado anatómico (AU)

Vitrectomía a cielo abierto en el estadio cicatrizal grado V: desprendimiento de retina total con configuración en embudo cerrado / Open vitrectomy in cicatricial stage V: total retinal detachment with close funel configuration

Se efectuó vitrectomía a cielo abierto en 23 ojos de 18 niños (entre 4 y 35 meses de edad) que presentaban una Retinopatia del prematuro (R.P.) en etapa cicatrizal grado V - desprendimiento de retina total con configuración en embudo cerrado. Al finalizar el seguimiento, la retina estaba aplicada en el polo posterior en 8 ojos (8/23 = 34,7%). El seguimiento osciló entre 1 y 48 meses (media = 14 meses; mediana = 12 meses). Se analiza la posible influencia de factores clínico-patológicos y quirúrgicos en el resultado anatómico