Anterior lamellar corneoscleral keratoplasty for the management of corneal thinning following treatment with mitomycin-C and interferon to treat highly suspected ocular surface squamous neoplasia: a case report.

A patient presented with corneoscleral thinning five months after the treatment of suspected ocular squamous surface neoplasia with mitomycin-C and interferon. For tectonic and aesthetic purposes, we decided to perform lamellar corneoscleral transplantation. The approach used established new tectonic support and corneal homeostasis. This technique might be an option in similar cases.

Rare case of mantle cell lymphoma of the lacrimal sac.

Mantle cell lymphoma of the ocular and periorbital regions is extremely rare but should be considered in the differential diagnosis of lesions affecting the periorbital tissues. In this study, we present a rare case of mantle cell lymphoma of the lacrimal sac in a 65-year-old male presenting with a mass in the lacrimal sac region and epiphora. After clinical examinations and imaging studies, the mucocele was misdiagnosed. Considering the unexpected findings during external dacryocystorhinostomy, a frozen biopsy was performed, which confirmed the diagnosis of lymphoma.

I-125 eye-plaque seed economics: To re-use or to not re-use? A single institutional cost savings analysis of re-using I-125 radioactive seeds for eye-Plaque brachytherapy.

INTRODUCTION: Iodine-125 (I-125) seeds, commonly used in low-dose rate brachytherapy for ocular malignancies, are often discarded after a single use. This study examines the potential cost savings at an institution with high ocular melanoma referrals, by re-using I-125 seeds for eye-plaque brachytherapy. METHODS: In this single-institutional retrospective analysis, data was collected from I-125 seed orders from 8/2019 through 10/2022. Information including number of seeds ordered per lot, number of plaques built per lot, and number of seeds used per lot were collected. Cost per lot of seed was assumed to be the current cost from the most recent lot of 35 seeds. RESULTS: During the study, 72 I-125 seed lots were ordered bi-weekly, with a median of 35 seeds per lot (Range: 15-35). Each seed was used on average 2.26 times prior to being discarded. The average duration of each seed lot used was 62.2 days (Range: 21-126). Each seed lot contributed to the construction of an average of 8.4 eye plaques (Range: 2-20). With seed recycling, 2,475 seeds were used to construct 608 eye-plaques. Without re-using practice this would require 5,694 seeds. This resulted in a percentage cost savings of 56.5%, with a total seed cost reduction of $344,884, or $559 per eye-plaque on average. CONCLUSION: This is the first study to evaluate cost savings relative to re-using I-125 seeds for eye plaques. The data demonstrates how an institution can decrease costs associated with I-125 radiation seeds used for eye-plaque brachytherapy by re-using them.

Primary basal cell carcinoma of the caruncle: case report and review of the literature.

We present a rare case of primary caruncle basal cell carcinoma (BCC), a condition with limited occurrences. Our patient, an 80-year-old woman without prior ocular pathological history, presented a 2x2mm pedunculated blackish nodular lesion on the caruncle of her left eye, without local conjunctival or cutaneous involvement. Histological analysis following complete excision confirmed the presence of basal cell carcinoma within the caruncle. Over a span of 30 months, no recurrence has been observed. While scant cases are documented in the literature, we conducted a review of these instances. Despite its infrequent manifestation, this condition should be taken into account when evaluating caruncular tumors, given its tendency to invade the orbit. Complete excision with free surgical margins is the treatment of choice, and adjuvant radiotherapy or chemotherapy might be considered.

Evaluation of Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum.

PURPOSE: To assess Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum and correlate with ocular surface changes. METHODS: This cross-sectional study evaluated patients with xeroderma pigmentosum. All patients underwent a comprehensive and standardized interview. The best-corrected visual acuity of each eye was determined. Detailed ophthalmic examination was conducted, including biomicroscopy examination of the ocular surface, Schirmer test type I, and meibography, and fundus examination was also performed when possible. Meibomian gland dysfunction was assessed by non-contact meibography using Oculus Keratograph® 5M (OCULUS Inc., Arlington, WA, USA). Saliva samples were collected using the Oragene DNA Self-collection kit (DNA Genotek Inc., Ottawa, Canada), and DNA was extracted as recommended by the manufacturer. Factors associated with abnormal meiboscores were assessed using generalized estimating equation models. RESULTS: A total of 42 participants were enrolled, and 27 patients underwent meibography. The meiboscore was abnormal in the upper eyelid in 8 (29.6%) patients and in the lower eyelid in 17 (62.9%). The likelihood of having abnormal meiboscores in the lower eyelid was 16.3 times greater than that in the upper eyelid. In the final multivariate model, age (p=0.001), mutation profile (p=0.006), and presence of ocular surface malignant tumor (OSMT) (p=0.014) remained significant for abnormal meiboscores. For a 1-year increase in age, the likelihood of abnormal meiboscores increased by 12%. Eyes with OSMT were 58.8 times more likely to have abnormal meiboscores than eyes without ocular surface malignant tumor. CONCLUSION: In the final model, age, xeroderma pigmentosum profile, previous cancer, and clinical alterations on the eyelid correlated with a meiboscore of ≥2. Meibomian gland dysfunction was common in patients with xeroderma pigmentosum, mainly in the lower eyelid. The severity of Meibomian gland dysfunction increases with age and is associated with severe eyelid changes.

HIV with initial ocular Kaposi sarcoma / HIV com sarcoma de Kaposi ocular inicial

ABSTRACT We present an interesting case of a 62-year-old black female, presented to the ophthalmological hospital with a little "nevus" on the left eye previously visualized at the mirror, with one month of development. Physical examination with slit lamp (biomicroscopy) showed a group of painless veins, with vascular redness, and a mass nodular aspect in the mid temporal bulbar conjunctiva, of approximately 2mmx4mm.

RESUMO Apresentamos o interessante caso de uma mulher negra de 62 anos, que deu entrada no hospital oftalmológico com um pequeno nevo no olho esquerdo previamente visualizado ao espelho, com 1 mês de evolução. O exame físico com lâmpada de fenda (biomicroscopia) mostrou um grupo de veias indolor e vermelhidão vascular, com uma massa de aspecto nodular na conjuntiva bulbar temporal média, de aproximadamente 2mmx4mm.

Uso del músculo temporal en reconstrucción periorbitaria post exéresis de carcinoma epidermoide cutáneo del globo ocular izquierdo / Use of the temporal muscle in post exeresis periorbital reconstruction of cutaneous epidermoid carcinoma of the left eyeball

Introducción. El carcinoma epidermoide cutáneo (CEC) es la segunda neoplasia cutánea más frecuente después del carcinoma basocelular. La incidencia del CEC ha aumentado de forma considerable durante los últimos 20 años y predicen un incremento en la próxima década. La mayoría de los CEC están localizados y se resuelven habitualmente mediante la extirpación quirúrgica u otros procedimientos locales. El uso del músculo temporal es una alternativa quirúrgica para corregir el defecto periorbitario tras la extirpación del CEC. Objetivo. Evaluar el resultado de la cobertura del músculo temporal en la corrección del defecto periorbitario. Material y métodos. Se presenta un caso quirúrgico de un paciente masculino, 62 años, que presenta una gran lesión tumoral que compromete el globo ocular, región orbitaria y periorbitaria izquierda, acompañado de dolor, anemia, astenia y pérdida ponderal de aproximadamente 20 libras. Con una evolución de 6 años. Conclusión. El uso del músculo temporal es una alternativa eficaz en la reconstrucción de lesiones craneofaciales, que ha sido utilizado por más de 100 años.

Introduction. Skin epidermoid carcinoma (SEC) is the second most common skin neoplasm after basal cell carcinoma. The incidence of SEC has increased considerably over the past 20 years and predicts an increase over the next decade. Most SECs are located and usually resolved by surgical removal or other local procedures. The use of the temporal muscle is a surgical alternative to correct the peri-orbital defect after removal of the SEC. Objective. To evaluate the result of temporal muscle coverage in the correction of the peri-orbital defect. Material and methods. There is a surgical case of a male patient, 62 years old who has a large tumor injury that compromises the eyeball, orbital region and left periorbital. Accompanied by pain, anemia, asthenia, and weight loss approximately 20 pounds. With an evolution of 6 years. Conclusion. The use of the temporalis muscle is an effective alternative in the reconstruction of craniofacial lesions that has been used for more than 100 years

The impact of the COVID-19 pandemic on the diagnosis and treatment of ocular cancer.

PURPOSE: To evaluate the impact of social isolation due to the COVID-19 pandemic on the number of new cases and therapeutic approaches at the Ocular Oncology division from the Universidade Federal de São Paulo (UNIFESP). METHODS: A retrospective study was conducted by medical records review of new patients treated before the pandemic from March 2019 to September 2019 (pre-pandemic group) and during the pandemic from March 2020 to September 2020 (pandemic group). Data regarding age, sex, ethnicity, place of origin, clinical diagnosis, time since referral, and proposed therapy were analyzed. RESULTS: We analyzed 186 new cases, 122 from the pre-pandemic group and 64 from the pandemic group, representing a decrease of 47.54% in new cases. There was no statistically significant change in sex, race, state of origin, history of cancer, age, or time with suspected cancer (p>0.05). A higher frequency of malignancies was observed in the pandemic group (68%) when compared to the pre-pandemic group (48.48%). Benign tumors were the most common diagnosis in the pre-pandemic group (41.80%), while conjunctival squamous cell carcinoma was the modal diagnosis in the pandemic group (31.25%). There was a decreasing trend (p=0.097) in the number of surgeries (-7.63%) and an increase in topical treatment (+10.68%). There was also a tendency to perform fewer surgeries in benign tumors and decreased follow-up visits. CONCLUSION: Our findings showed a significant decrease in the number of new cases referred to the Ocular Oncology service. Moreover, the pandemic led to a switch in the therapeutic approach with preference to non-invasive treatments that would demand operating rooms. A drastic increase of cases perhaps in advanced stages might be expected because of the decrease observed in the first six months of quarantine.

Carcinoma de células escamosas corneal em um cão - uso da Mitomicina C 0, 02% como adjuvante no tratamento / Corneal squamous cell carcinoma in a dog - use of Mitomycin C 0. 02% as an adjuvant therapy

Background: Although Squamous Cell Carcinoma (SCC) is most commonly seen in the epidermis, this malignant neoplasm can manifest in various other tissues. A wide range of factors may be related to the development of SCC in the cornea, with continuous exposure to ultraviolet radiation and chronic friction to the ocular surface being the most accepted theories. In addition to surgical procedures, the use of mitomycin C in the topical treatment of corneal SCC has shown good results in therapeutic management. Thus, the objective of the current work is to report the satisfactory response observed in the use of mitomycin C in a case of SCC in the cornea of a dog. Case: A 9-year-old male Pug dog was attended by the Veterinary Ophthalmology and Microsurgery Sector (SOMVET) of the University Veterinary Hospital (HVU) of the Federal University of Santa Maria (UFSM) with Squamous Cell Carcinoma (SCC) in the cornea of the left eye, which had recurred after a previous surgical intervention. Secretion and discomfort in the left eye were noted during clinical examination. In addition, both eyes presented pigmentary keratitis in the medial corner. Surgical excision of the neoplasm was performed using the surgical technique of anterior lamellar keratectomy. In the immediate postoperative period, topical therapy was started with eye drops based on mitomycin C at 0.02%, for a period of 28 consecutive days. The use of this chemotherapy drug in the topical form was intended to minimize the chances of recurrence of the clinical condition, since the patient is predisposed to this alteration. In addition, supportive therapy was implemented to improve patient comfort, consisting of the use of tobramycin-based eye drops (6 times a day, for 14 days), atropine 1% eye drops (BID, for 3 days), lubricating eye drops based on sodium hyaluronate (3 times a day, for continuous use), and immunomodulatory eye drops based on tacrolimus 0.02% (twice a day, for continuous use). The patient was evaluated 7, 14, 21, and 28 days after surgery, when good results were observed. One year after treatment, the dog was still showing no signs of recurrence of the treated clinical condition. Discussion: It is known that chronic friction on the surface of the cornea predisposes to the diagnosis of corneal SCC. Accordingly, in the clinical examination of the patient in this report, the presence of bilateral pigmentary keratitis was observed, an alteration that leads to a framework of chronic aggression to the cornea. Surgical treatment is recommended to remove the tumor mass in the ocular region. However, in cases of corneal SCC, the literature highlights that recurrence after surgical excision is a common factor. As the patient in this study arrived at the clinic with a history of recurrence, topical therapy with mitomycin C associated with surgical treatment was instituted. This chemotherapy drug has shown encouraging results in the treatment of some neoplasms, especially SCC. Its use in this case supported previous findings, pointing to a satisfactory result in which the patient had no recurrences after one year of follow-up. In addition, the concentration and frequency used of the active ingredient did not lead to adverse effects in the short or medium term.

OVOL1 immunohistochemical expression is a useful tool to diagnose invasion in ocular surface squamous neoplasms.

BACKGROUND AND OBJECTIVES: OVOL1 is a gene that negatively regulates mesenchymal transformation, which allows epithelial cells to invade the stroma. On the other hand, it negatively regulates c-Myc, which has a positive effect on cell proliferation. The aim of this study is to evaluate the expression of OVOL1 and c-Myc in ocular surface squamous neoplasia (OSSN). PATIENTS AND METHODS: Cross-sectional cohort study of 36 samples including 6 squamous papillomas, 19 conjunctival intraepithelial neoplasms, 6 squamous carcinomas and 7 normal conjunctivae were evaluated using immunohistochemistry against OVOL1 and c-Myc. The expression of both markers was analysed using the H-score (intensity 1-3 multiplied by the percentage of positive cells). RESULTS: Percentages of 98 and 100 of the OSSN, and 57 and 71% of the normal conjunctivae expressed OVOL1 and c-Myc respectively, however, the mean H-score of OVOL1 and c-Myc was higher in the OSSN than in normal conjunctivae group (P=0.0001 in both). Within the OSSN, OVOL1 demonstrated a higher H-score in the conjunctival intraepithelial neoplasms and papilloma, compared to the squamous carcinoma (P<0.01) group. c-Myc did not show differences between the OSSN groups. An H-score lower than 35 differentiates a squamous cell carcinoma from other OSSN lesions with a sensitivity of 83.3% and a specificity of 100%. CONCLUSIONS: The expression of OVOL1 is a useful tool to differentiate between a squamous carcinoma of conjunctival intraepithelial neoplasms and papilloma. OVOL1 could play a role in the invasiveness of squamous neoplasms and places it as a potential therapeutic target.

Association of high-risk human papillomavirus with ocular surface squamous neoplasia: a case-control study in Mexico.

OBJECTIVE: To investigate the association of high-risk hu-man papilloma virus (HR-HPV) and other risk factors with ocular surface squamous cell neoplasia (OSSN). MATERIALS AND METHODS: We obtained DNA from 22 fresh frozen OSSN tissues and 22 pterygia as controls, we used a broad-spectrum HPV DNA amplification short PCR fragment to identify HPV infection in all specimens and then genotyped HPV by a reverse hybridization line probe assay. We also obtained demographic, sun exposure, and tobacco consump-tion information. RESULTS: HR-HPV frequency was 40.9% in the OSSN group and 4.5% in the pterygia group (p=0.009). After covariate adjustment, OSSN was associated with HR-HPV (OR=16.3, 95%CI=1.2,218.1, p=0.03) and sunburn (OR=10.8, 95%CI=1.8,86.0, p=0.02). CONCLUSIONS: Ocular surface squamous cell neoplasia is a multifactorial disease. The strong association between HR-HPV and OSSN, suggests that HR-HPV could play an etiological role in OSSN development.

Caracterización de pacientes con cáncer ocular en un hospital de Santiago de Cuba / Characterization of patients with eye cancer in a hospital from Santiago de Cuba i: en

Introducción: La neoplasia ocular puede afectar el ojo, los anexos y la órbita. El tratamiento eficaz depende de un diagnóstico precoz, presuntivo y certero. Objetivo: Caracterizar a los pacientes con cáncer ocular según variables de interés. Método: Se realizó un estudio observacional, descriptivo y retrospectivo de 58 pacientes con tumor maligno ocular, confirmado mediante biopsia, atendidos en el Servicio de Cirugía Plástica Ocular del Centro Oftalmológico del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde octubre del 2015 hasta igual periodo del 2020. Se utilizó la media para las variables cuantitativas. Resultados: En la serie la edad media fue de 62,49 años; primaron el sexo masculino (51,7 %) y el color de la piel mestizo (53,4 %). La localización más frecuente de las lesiones tumorales en los anexos fue en los párpados (53,4 %) y la conjuntiva (41,4 %). Los tipos histológicos predominantes fueron carcinoma basocelular palpebral (44,8 %) y carcinoma epidermoide de la conjuntiva (41,4 %). La estadificación del tumor se estableció: T1 en 47 pacientes, T2 y T3 en 4, así como T4 en 3. Conclusiones: El control del cáncer ocular es de suma importancia, pues permite trazar estrategias para el diagnóstico precoz y el tratamiento adecuado de los pacientes.

Introduction: The ocular neoplasm can affect the eye, annexes and orbit. The effective treatment depends on an early, presumptive and accurate diagnosis. Objective: To characterize patients with eye cancer according to variables of interest. Method: An observational, descriptive and retrospective study of 58 patients with eye malignancy confirmed by means of biopsy was carried out. They were assisted in the Ocular Plastic Surgery Service of the Ophthalmologic Center at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from October, 2015 to the same period in 2020. The mean was used for the quantitative variables. Results: In the series the mean age was of 62.49 years; there was a prevalence of the male sex (51.7 %) and the mixed race color of the skin (53.4 %). The most frequent localization of the tumoral lesions in the annexes was in the lids (53.4 %) and the conjunctive (41.4 %). The predominant histologic types were palpebral basal cell carcinoma (44.8 %) and squamous cell carcinoma of the conjunctive (41.4 %). The estadification of the tumor was established: T1 en 47 patients, T2 and T3 in 4, as well as T4 in 3. Conclusions: The control of the eye cancer is very important, because it allows to trace strategies for the early diagnosis and the appropriate treatment of patients.

Linfoma intraocular em cães - achados da ultrassonografia contrastada e elastografia ARFI / Intraocular lymphoma in dogs - findings of contrast enhanced ultrasound and ARFI elastography

Background: Ocular lymphoma can affect the iris, conjunctiva, choroid, and retina and is mostly associated with multicentric disease. Elastography is an ultrasound technique that provides noninvasive, pain-free assessment of tissue stiffness. It has the ability to assess subtle changes throughout the organ as well as focal lesions. Microbubble contrast ultrasound enables the detection of incipient vascular flows, which are difficult to detect using traditional ultrasound methods. This study aimed to describe acoustic radiation force impulse (ARFI) elastography and microbubble contrast ultrasound findings in the eyes of two dogs diagnosed with intraocular T-cell lymphoma. Cases: Case 1. Physical examination revealed an exophytic mass in the left eye. Schirmer test revealed a secretion of 22 mm/min. Negative threat reflex, glare, direct pupillary light reflex, and consensual response were also noted. Biomicroscopy revealed hyperplasia of the third eyelid, overlapping with the affected eye. When the membrane was removed, moderate conjunctival hyperemia, mucoid secretion, and buphthalmia were observed. In addition, significant corneal edema was present, making it impossible to visualize the anterior chamber and perform fundus examination. The intraocular pressure, as measured with a rebound tonometer, was 39 mmHg. B-mode ultrasonography identified amorphous, hyperechoic, and heterogeneous structures throughout the anterior chamber, iris, and ciliary body. The elastogram showed that the mass had greenish tones and intermediate stiffness, and the mean SWV of the ciliary body and iris was 2 m/s. Contrast-enhanced ultrasound (CEUS) revealed vascularization of the neoformation region, with wash-in, peak, and wash-out values of 9.89 s, 24.56 s, and 107.87 s, respectively. Case 2. On physical examination, a change in the shape of the right pupil was observed. Schirmer test revealed a secretion of 20 mm/min, with negative threat, glare, and pupillary reflexes to direct and consensual light. Biomicroscopy revealed neoformation from 7 am to 11 am in the sclera, retina, and choroid complex, concomitant with dyscoria and conjunctival hyperemia. The intraocular pressure, as measured by rebound tonometry, was 33 mmHg. Fundoscopy revealed a mass in the temporal region and focal retinal detachment. No changes were observed in the contralateral eye. B-mode ultrasound revealed an increase in volume in the temporal region of the iris, ciliary body, and choroid with diffuse heterogeneity and partial retinal detachment. Elastographic examination revealed shades of green and yellow compatible with increased tissue stiffness. On quantitative examination, the mean SWVs of the ciliary body and iris were 3.14 m/s. On CEUS, the neoformation region presented wash-in, peak, and wash-out values of 8.67 s, 22.33 s, and 80.20 s. Discussion: B-mode ultrasonography established the tumor extent and evaluated echogenicity, verifying the involved ocular structures. The examination played an important role in the diagnosis as well as clinical management. ARFI elastography can detect small tissue changes, helping to define nodules and masses more reliably, in addition to allowing the verification of tissue stiffness. In both dogs, it was possible to verify that the masses presented greater rigidity than the adjacent tissues both qualitatively and quantitatively. In previous studies, it was found that cutaneous and breast lymphomas in humans were more rigid than adjacent tissues on elastography. This increase in rigidity and heterogeneity observed on elastograms can be explained by the extramedullary interactions of the matrix in T-cell lymphomas. Tumor growth is dependent on the blood supply, which was evaluated using CEUS in these cases. Furthermore, the ciliary body contrast filling times were longer than those described in normal dogs.

Pólipo fibroepitelial atípico em córnea de um cão Lhasa Apso / Atypical fibroepithelial polyp in the cornea of a Lhasa Apso dog

Background: Fibroepithelial polyps are benign tumors of mesenchymal and ectodermal origin. Regarding the localization related to the cutaneous region, they may affect the eyelid and periocular area. In veterinary medicine, polyps located in the urethra of dogs and monkeys, vagina of bitches and on the skin have been described. Fibroepithelial polyps may present as single to multiple nodules, exophytic to pedunculated, usually arising on a smooth surface of a common base. The aim of this paper is to describe the ocular and histopathological changes of a corneal fibroepithelial polyp of recurrent character in a dog. Case: A 20-year-old Lhasa Apso dog, with a history of progressive corneal neoformation in the right eye for 4 months. Patient was submitted to routine ophthalmic evaluation. At biomicroscopy, a discrete mucopurulent discharge was observed in the nasal corner, a nodule in the lower eyelid (± 3 mm), moderate conjunctival hyperemia, vascularization and corneal edema between 12 and 5 h, presence of a pinkish proliferative mass in 3 h, affecting the anterior stroma and opacity of the lens, Schirmer's Tear Test (STT) 20 mm/min and intraocular pressure (IOP) 10 mm/Hg. In the left eye, the STT and IOP were within normal range (17 mm/min and 11 mg/Hg, respectively) and at biomicroscopy only lens opacity was observed. Given the presence of the neoformation in the cornea, the patient underwent lamellar keratectomy to excise the mass and third eyelid flap. The tissue was then submitted to histopathology. The histopathological examination showed a proliferation of fibrous component with areas presenting reactive fibroblasts, with acidophilic cytoplasm and with little volume and slight neovascularization, presence of hyperplasia of the lining epithelium and cells with round to oval nuclei, with inconspicuous nucleoli, compatible with fibroepithelial polyp, without evidence of malignancy. After 18 months, the patient presented recurrence of the condition with a history of slow evolution (about ten months). The ophthalmic evaluation showed lesions very similar to the initial one, describing a recurrence of the lesion. Discussion: Corneal neoplasms are uncommon in dogs. The clinical findings in patients with ocular neoplasms include irregular to nodular masses, gray to reddish in color, and typically associated with a vascular supply. These features are related to the type of tumor and its degree of evolution. There are reports in the literature of ocular neoplasms such as squamous cell carcinoma, papilloma, melanocytoma, fibrosarcoma, hemangiosarcoma, melanoma, lymphoma. Related to fibroepithelial polyp with ocular involvement, there are rare reports in human literature and none in veterinary medicine. There is a human description of the presence of a polyp affecting the cornea associated with a corneal dermoid and e other cases of polyps of conjunctival origin. As far as treatment is concerned, the polyp should be surgically removed because of the possibility of recurrence, tissue metaplasia, or even transformation into a malignant tumor, as seen in the case reported here, in which even with surgical removal there was recurrence and metaplasia of the cells. Based on the histopathological findings, it can be concluded that this is a fibroepithelial polyp with a recidivating characteristic, not well described in the veterinary literature, with an atypical presentation affecting the cornea.

Primary corneal hemangiosarcoma in a tapir (Tapirus terrestris)

Background: Hemangiosarcoma is a malignant vascular tumor commonly described in veterinary ophthalmology as emerging at the margin of the third eyelid and bulbar conjunctiva. The primary corneal attachment of the tumor is considered rare, as the cornea is an avascular structure, but there are sparse reports of primary occurrences in the cornea of dogs, cats, and horses. No reports were found in wild animals. The Tapirus terrestris, commonly known as Tapir, is a perissodactyl mammal that inhabits South America regions, being considered the largest terrestrial mammal of Brazil and one of the most popular animals in zoos in various countries. This paper aims to report the first case of primary corneal hemangiosarcoma in a 25-year-old female Tapir (Tapirus terrestris) held in captivity. Case: A 25-year-old Tapirus terrestris female presented an irregular mass in the right cornea, mucopurulent secretion, and inconclusive previous cytological evaluation. It also had a history of a milky cornea for many years, and in the last 12 months, a tissue growth was observed, as well as the occurrence of mucopurulent secretion. The menace response in the right eye was negative. In the ophthalmologic examination, a red-colored, lobed, hemorrhagic, and ulcerated mass occupying approximately 90% of the cornea was observed, and in the peripheral cornea, there was an intense discoloration. Due to the extension of the mass and visual loss, the transpalpebral enucleation was performed under general inhalation anesthesia. The histopathological analysis evidenced a vascular tumor restricted to the central peripheral cornea, composed of blood vessels of small and large caliber, showing polygonal endothelial cells with moderate atypia, anisocytosis, and anisocariasis, in addition to dense stroma and inflammatory cells. The mass occupied the anterior corneal stroma, and there was no involvement of bulbar conjunctiva, sclera, or intraocular structures. The immunohistochemical study revealed the positivity of neoplastic cells for CD31, and the proliferative index of the lesion was evaluated by the Ki-67 as inferior to 10%. Discussion: The histopathologic and immunohistochemical examinations evidenced a hypercellular lesion, and the diagnosis of primary corneal hemangiosarcoma (HSA) was possible due to the significant cellular atypia identified in the lesion. To the authors' knowledge, this is the first case of corneal hemangiosarcoma described in Tapirus terrestris. The HAS is a malignant neoplasm originating in the vascular endothelial cells. There is a significant correlation between the HSA and prolonged exposure to solar radiation. The tapir of this report lived in a high-altitude region with exposure to ultraviolet rays; therefore, it might be an important predisposing factor for the HSA emergence. The chosen treatment for vascular tumors according to the visual prognostic is the lamellar keratectomy; however, the transpalpebral enucleation was the elected treatment since the eye was not visual, the neoplasm had a great extension, the animal was in advanced age and lived in captivity, and it was difficult to handle the animal without sedation to perform adjuvant therapies. Since the mass corresponded to 90% of the cornea, total removal with free edges would not be possible as described in the literature, and, therefore, there was an increased risk of relapse. In the follow-up after 3 years of surgical excision, the animal remained free of metastasis, reinforcing the diagnosis of primary corneal hemangiosarcoma.

Development and usability of a photograph-based smartphone app for ocular surface tumor screening / Desenvolvimento e usabilidade de um aplicativo para smartphones baseado em fotografias para rastreio de tumores de superfície ocular

ABSTRACT Objective: To develop and examine the usability of a mobile application aimed at improving knowledge about ocular surface tumors among medical students, general practitioners and ophthalmologists. Methods: A cross-sectional quantitative study was carried out by a multidisciplinary team and developed in three stages: administration of a specific questionnaire to medical students, assessing the demand for the application, creation and development of the application in collaboration with the Technological Innovation Laboratory of Centro Universitário Christus and usability assessment. General practitioners and ophthalmologists were selected to answer the System Usability Scale questionnaire. Data were exported into the Statistical Package for the Social Sciences, version 20.0 Windows, for quantitative analysis. Results: The OncoEye application was developed for the iOS and the Android platforms and included four main menus: Glossary, Patients, Referrals and Queries. Most students (89.9%) considered the development of the application important for wider access to information about the topic. Most students (39.9%) were able to recognize ocular lesions and 26.1% could distinguish between benign and malignant conditions. System Usability Scale questionnaire responses revealed good usability, with an average score of 92.65. Users (100%) described the application as user-friendly and well- integrated. Conclusion: An innovative application for ocular surface tumors was created and developed. The application achieved good levels of acceptance and was described as user-friendly by users.

RESUMO Objetivo: Desenvolver e avaliar a usabilidade de um aplicativo para dispositivos móveis que aprimore o conhecimento de estudantes de medicina e de médicos sobre tumores da superfície ocular. Métodos: Foi realizado estudo transversal e quantitativo por uma equipe multiprofissional, consistindo em três etapas: realização de um questionário específico com estudantes de medicina, avaliando a necessidade de elaboração do aplicativo; criação e desenvolvimento do aplicativo pelo Laboratório de Inovação Tecnológica do Centro Universitário Christus e avaliação de usabilidade. Médicos generalistas e oftalmologistas foram selecionados para responder ao questionário System Usability Scale. Os dados foram exportados para o programa Statistical Package for the Social Sciences, versão 20.0, para Windows para análise quantitativa. Resultados: O aplicativo OncoEye foi desenvolvido com quatro menus principais: Glossário, Pacientes, Encaminhamento e Perguntas. Dentre os estudantes, 89,9% consideraram o desenvolvimento do aplicativo importante para orientação sobre o tema, 39,9% souberam reconhecer lesão ocular, e 26,1% puderam diferenciar lesão ocular maligna ou benigna. As respostas dos usuários à ferramenta System Usability Scale demonstraram boa usabilidade, com pontuação média de 92,65 (87,74 a 97,55). Todos os usuários consideraram o aplicativo de fácil manuseio e bem integrado. Conclusão: Um aplicativo inovador para tumores da superfície ocular foi criado e desenvolvido, apresentando boa aceitação e fácil manuseio pelos usuários.

Análise do perfil clínico de pacientes portadores de neoplasia ocular escamosa atendidos em hospital referência de oculoplástica / Analysis of the clinical profile of patients with squamous ocular neoplasms attended at a reference hospital of oculoplastics

RESUMO Objetivo Analisar o perfil clínico de pacientes portadores de neoplasias escamosas da superfície ocular. Métodos Foram avaliados os principais fatores de risco envolvidos na gênese das neoplasias escamosas da superfície ocular, as características clínicas dos pacientes e os hábitos comportamentais associados. Foram incluídos neste trabalho de coorte histórica 80 pacientes com diagnóstico anatomopatológico de neoplasia escamosa da superfície ocular atendidos entre os anos de 2010 e 2020 em um hospital referência em oculoplástica e segmento anterior de Santa Catarina. Os dados clínicos e desfechos foram avaliados por meio da análise de prontuário e entrevista, sendo posteriormente tabulados no Excel e submetidos à analise estatística por meio do software Statistical Pakage for the Social Sciences, versão 16. Resultados Foi observado que 73,8% (n=59) eram do sexo masculino. A média de idade da amostra foi de 62 anos. Quanto ao fototipo de pele, de acordo com a escala de Fitzpatrick, constatou-se que a maioria apresentou os fototipos 1 e 2 (22; 27,5% e 44; 55%, respectivamente). Em relação à exposição ocupacional ao sol/radiação, 48% (n=60) apresentaram história de exposição ocupacional, sendo que, destes, 28 pacientes trabalhavam no setor de agricultura. Dos pacientes da amostra, 33 (41,2%) apresentavam histórico pessoal de neoplasias de pele, sendo que, destes, três apresentavam diagnóstico de xeroderma pigmentoso. Quanto ao hábito de uso de fatores de proteção solar, 61% (n=49) da amostra negou o hábito. Foi evidenciada associação estatisticamente significativa entre o hábito de usar fatores de proteção solar e histórico pessoal de neoplasias de pele. Em relação ao tipo de neoplasia escamosa, a maioria dos pacientes (72; 90%) apresentou diagnóstico anatomopatológico de carcinoma espinocelular ocular. Conclusão O perfil clínico epidemiológico dos pacientes portadores de neoplasias escamosas da superfície ocular neste estudo, predominantemente de carcinoma espinoceular ocular, foi de homens, idosos, de pele clara (fototipo 2) e com histórico importante de exposição aos raios solares ultravioleta A e B. Comorbidades imunodepressoras (HIV e transplante de órgão sólido) e doenças dermatológicas (albinismo e xeroderma pigmentoso) associaram-se ao aparecimento das neoplasias escamosas da superfície ocular em idade mais precoce. Em pacientes com histórico pessoal prévio de neoplasias de pele, foi evidenciado o hábito de uso de fatores de protetor solar mais presente em relação aos demais.

ABSTRACT Objective To analyze the clinical profile of patients with ocular surface squamous neoplasms (OSSN). Methods The main risk factors involved in the genesis of the ocular surface squamous neoplasms, the clinical features, and the behavioral habits associated were evaluated. This historical cohort study included 80 patients with anatomopathological diagnosis of OSSN who were treated between 2010-2020 at a reference hospital in oculoplastic and anterior segment in Santa Catarina. The clinical data and outcomes were evalated through the analysis of medical records and interviews, being later tabulated in Excel and analyzed using the SPSS 16 software. Results Regarding the clinical profile of the patients in the sample, 73.8% (n = 59) were male. The mean age of the sample was 62 years old. As for the skin phototype, according to the Fitzpatrick scale, most of the sample presented the phototype 1 and 2 (27.5% n = 22; and 55% n = 44 respectively). Regarding occupational exposure to the sun / radiation, 48% (n = 60) had history of occupational exposure, and of these, 28 patients worked in the agricultural area. Of the patients of the sample, 33 (41.2%) had a personal history of skin neoplasms, and of these, 3 had diagnosis of xeroderma pigmentosum. As for the habit of using sun protection factors, 61% (n = 49) of the sample denied the habit. A statistically significant association was evidenced between the habit of using sun protection factors and people's history of skin cancer. Regarding the type of squamous neoplasia, most patients in the 90% sample (n = 72) had an anatomopathological diagnosis of ocular squamous cell carcinoma. Conclusion The clinical epidemiological profile of patients with OSSN in this study, predominantly ocular squamous cell carcinoma, was men, elderly, fair-skinned (phototype 2) and with an important history of exposure to UVA and UVB rays. Immunosuppressive comorbidities (HIV, solid organ transplant) and dermatological diseases (albinism, xeroderma pigmentosum) are associated with the appearance of OSSN at an early age. In patients with a previous personal history of skin neoplasms, the habit of using sunscreen factors was more present than in the other patients.