Bone metastasis in a case of primary acquired melanosis with atypia resulting from conjunctiva melanoma.

A 66-year-old woman presented to a tertiary referral centre with a diagnosis of limbal stem cell deficiency secondary to multiple treatments for primary acquired melanosis (PAM) by her referring ophthalmologists. She was known with primary acquired melanosis with severe atypia of the right eye which had been treated with several excisions, cryotherapy and topical chemotherapy. She had PAM over 360° of alternating intensity. Throughout the follow-up period, she developed a cataract and subsequent a retinal detachment for which she underwent a phacovitrectomy on the right eye. There was no nodule present nor did the routine lymph nodes inspection show any enlargement. No abnormalities were observed on intranasal examination. Seven years after the last excision, a metastasis to the spine (Th3) was diagnosed. A complete systemic work-up and a pathological examination did not show any alternative primary melanoma in the body. The original histological material was reviewed again by an ophthalmopathologist. After a new round of stains and immunohistochemistry, the presence of atypical melanocytes in both the epithelium and stroma were found in a scar region leading to a renewed conclusion that the PAM in question was actually the primary melanoma.

Intraocular bag-in-the-lens exchange: indications, outcomes, and complications.

PURPOSE: To report the indications, outcomes, and complications regarding bag-in-the-lens (BIL) intraocular lens (IOL) exchange over a period of 13 years in a tertiary ophthalmologic center. SETTING: Department of Ophthalmology of the University Hospital of Antwerp, Belgium. DESIGN: Observational retrospective study. METHODS: Between 2003 and 2020, 12 176 patients were operated using the BIL technique. Adult patients who underwent an intraocular BIL exchange were included, and the demographics, indications, outcomes, and complications were recorded. RESULTS: 59 eyes (0.48%) of 59 patients who underwent a BIL exchange between 2007 and 2020 were included. The mean age was 61.15 ± 13.53 years. The mean time between primary surgery and IOL exchange was 25.73 ± 41.88 months. The main indication for explantation was refractive surprise mostly related to patient risk factors, for example, preoperative corneal and refractive surgery. The mean preoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuity were 0.36 ± 0.24 and 0.79 ± 0.24, respectively. The postoperative 1-month UDVA and CDVA were 0.66 ± 0.28 and 0.86 ± 0.19, respectively. The improvement in UDVA was statistically significant (<0.0001). The most common intraoperative complication was damage to the anterior hyaloid in 9 eyes (15%), which did not prohibit reimplantation of a secondary BIL. CONCLUSIONS: BIL to BIL exchange was a viable and successful technique that provides good refractive results with few, manageable complications. Because of the tertiary profile of the study center with referral of complex cases, BIL was the preferred IOL in patients at risk for postoperative refractive surprise.

Fifteen years of IOL exchange: indications, outcomes, and complications.

PURPOSE: To report the indications, frequency, and outcomes regarding intraocular lens (IOL) exchange in 2 university hospital tertiary referral settings over a period of 15 years. SETTING: Ophthalmology departments of the University Hospital Antwerp and the University Hospital Leuven, Belgium. DESIGN: Retrospective cross-sectional study. METHODS: In this retrospective study, included were patients who underwent an IOL exchange between 2002 and 2017. Patient demographics, surgical indication, comorbidities, visual outcomes, and complications were reported. Patients who underwent IOL repositioning or add-on IOL implantation or extraction, and patients who were left aphakic, were excluded. RESULTS: Included in the study were 492 eyes. The mean age was 66.0 ± 13.3 years (range 19-91 years). The mean time between primary surgery and IOL exchange was 54.61 ± 67.07 months (range 0-343 months). Primary indication for explantation was IOL opacification, and the most common ophthalmic comorbidity was a previous history of vitreoretinal surgery. Preoperatively, the mean uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) were 0.47 ± 0.27 (range 0-1) and 0.61 ± 0.32 (range 0-1.2), respectively. Postoperative UCVA and CDVA was 0.7 ± 0.3 (range 0-1.2) and 0.8 ± 0.28 (range 0.05-1.6), respectively. The increase in both CDVA and UCVA was statistically significant (P < .001, paired t test). The most common complication perioperatively was vitreous prolapse, which occurred in 61 eyes (16%). CONCLUSIONS: IOL exchange is a challenging yet valuable treatment option for a wide spectrum of problematic IOL outcomes. The most common indication remains IOL opacification, although IOL dislocation and patient dissatisfaction are increasing as indications.