American Journal of Ophthalmology最新文献

{"title":"Circulating Tumor DNA in Conjunctival Melanoma: Landscape and Surveillance Value","authors":"Hao Tian ,&nbsp;Hanhan Shi ,&nbsp;Jie Chen ,&nbsp;Tianyu Zhu ,&nbsp;Ziyue Huang ,&nbsp;Chunyan Zong ,&nbsp;Shichong Jia ,&nbsp;Jing Ruan ,&nbsp;Shengfang Ge ,&nbsp;Haihua Yuan ,&nbsp;Yanjie Zhang ,&nbsp;Bin Jiang ,&nbsp;Rong Liu ,&nbsp;Renbing Jia ,&nbsp;Xianqun Fan ,&nbsp;Shiqiong Xu","doi":"10.1016/j.ajo.2024.10.012","DOIUrl":"10.1016/j.ajo.2024.10.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the surveillance value of circulating tumor DNA (ctDNA) for detecting distant metastasis and indicating systemic therapeutic efficacy in conjunctival melanoma (CoM).</div></div><div><h3>Design</h3><div>Retrospective, observational case series.</div></div><div><h3>Methods</h3><div>From July 2021 to June 2023, 30 CoM patients in our center underwent plasma ctDNA assessment, out of which 12 individuals presented with distant metastases. We employed a 437-gene panel containing common mutations in CoM and common drug-sensitive mutations using next-generation sequencing (NGS) technology to analyze ctDNA mutations in plasma. Clinical and radiological records were used to assess tumor status. The relationship between ctDNA characteristics, tissue gene mutations, and clinical manifestations were explored.</div></div><div><h3>Results</h3><div>CoM-related driver mutations were detected in ctDNA of 11 patients with distant metastasis. The ctDNA were highly consistent with tissue sequencing, mutual driver mutation including BRAF, NRAS, KRAS, NF1, CTNNB1, and TP53 mutation. those with a higher VAF had shorter progression-free survival (PFS, <em>p</em> = .0475) and overall survival (OS, <em>p</em> = .0043). The ctDNA variant allele fraction (VAF) was not correlated with the sum of the longest diameters (SLD, <em>p</em> = .8192) in distant metastasis patients.</div></div><div><h3>Conclusions</h3><div>Positive plasma ctDNA reflected the presence of metastases. The ctDNA could be used as a complement or alternative to tissue sequencing. High VAF ctDNA might indicate rapid disease progression in distant metastasis patients.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"270 ","pages":"Pages 67-76"},"PeriodicalIF":4.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Axial Shortening Effects of Repeated Low-level Red-light Therapy in Children With High Myopia: A Multicenter Randomized Controlled Trial","authors":"Guihua Liu ,&nbsp;Lin Liu ,&nbsp;Hua Rong ,&nbsp;Li Li ,&nbsp;Xuan Liu ,&nbsp;Zhiyang Jia ,&nbsp;Hua Zhang ,&nbsp;Biying Wang ,&nbsp;Desheng Song ,&nbsp;Jiamei Hu ,&nbsp;Xinrui Shi ,&nbsp;Bei Du ,&nbsp;Ruihua Wei","doi":"10.1016/j.ajo.2024.10.011","DOIUrl":"10.1016/j.ajo.2024.10.011","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To evaluate the effectiveness and safety of repeated low-level red-light (RLRL) in delaying the progression of high myopes with –6.00 diopters (D) or worse.</div></div><div><h3>DESIGN</h3><div>Multicenter, randomized, parallel-group, single-blind clinical trial. A total of 202 high myopic children aged 7 to 12 years with cycloplegia spherical equivalent (SE) refraction ≤–6.00 D, astigmatism less than 2.50 D, and anisometropia of 1.50 D or less were enrolled from March 2022 to December 2022. Follow-up was completed in December 2023.</div></div><div><h3>METHODS</h3><div>Eligible participants were randomly allocated to the intervention (RLRL + single vision spectacle) or the control group (single vision spectacle). The RLRL treatment was administered every day for 3 minutes, twice a day, with an interval of at least 4 hours. The primary outcome was the change in axial length (AL) at 12 months compared with baseline. Secondary outcomes included changes in SE, changes in choroidal thickness (ChT), and changes in retinal thickness (RT) in different circle sectors. Outcomes were analyzed by means of intention-to-treat and per-protocol methods.</div></div><div><h3>RESULTS</h3><div>After 12 months of treatment, AL and SE changes were –0.11 ± 0.25 mm and 0.18 ± 0.63 D for the RLRL group and 0.32 ± 0.09 mm and –0.80 ± 0.42 D for the control group, respectively. Axial shortening &gt;0.05 mm was 59% in the RLRL and 0% in the control group at 12 months. ChT and RT from a single center were analyzed. In the RLRL group, ChT was thickened in all sectors at 12 months. RT was increased in parafoveal and perifoveal circles. In the control group, all sectors of ChT and only perifoveal RT were significantly thinner at 12 months. The multivariate linear regression model revealed significant correlations between changes in the ChT central foveal circle and RT perifoveal circle at 1 month and AL changes at 12 months. No fundus structure changes, afterimage exceeding 6 minutes, or best-corrected visual acuity decrease were reported.</div></div><div><h3>CONCLUSIONS</h3><div>RLRL could effectively shorten the AL and inhibit the progression of myopia in high myopic patients with –6.00 D or worse. AL shortening is sustained over 12 months of treatment. These observed changes appeared to be associated with increases in ChT and RT.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"270 ","pages":"Pages 203-215"},"PeriodicalIF":4.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal Imaging Characteristics and Correlation to Outcomes in Patients With Central Retinal Artery Occlusion Presenting to a Large Academic Center","authors":"Sandra Hoyek ,&nbsp;Melissa Yuan ,&nbsp;Romy Bejjani ,&nbsp;David N. Zacks ,&nbsp;Joan W. Miller ,&nbsp;Demetrios G. Vavvas ,&nbsp;Nimesh A. Patel","doi":"10.1016/j.ajo.2024.10.004","DOIUrl":"10.1016/j.ajo.2024.10.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To characterize a large modern cohort of patients with central retinal artery occlusion (CRAO) by describing presenting features and outcomes relating to manually segmented optical coherence tomography (OCT) features, angiographic reperfusion, and visual recovery.</div></div><div><h3>Design</h3><div>Retrospective clinical cohort study.</div></div><div><h3>Methods</h3><div>Patients with CRAO (ICD-10: H34.1) initially presenting to a tertiary referral center between January 2017 and December 2021 were included. Demographics, eye exam findings, fundus photographs, OCT, and fluorescein angiography were analyzed. Main outcome measures included total and inner retinal thickness on macular OCT, reperfusion, visual outcomes, and development of neovascularization.</div></div><div><h3>Results</h3><div>A total of 145 eyes of 144 patients with mean age at of 69.4 ± 13.6 years were included. The mean time to presentation was 1.6 ± 4.2 days, with 19% examined within 4.5 hours and 26% within 6 hours of vision loss. 19% had cilioretinal artery (CLRA) sparing. Mean initial visual acuity (VA) was 1.68 ± 1.10 Logarithm of the Minimum Angle of Resolution (LogMAR) (CLRA sparing) compared to 2.53 ± 0.58 LogMAR (non-CLRA sparing), <em>P</em> &lt; .001. 32% had elevated inflammatory makers. Out of 47 eyes with final fluorescein angiography, one-third showed some reperfusion. Final vision was 1.40 ± 1.16 LogMAR (CLRA sparing) compared to 2.46 ± 0.81 (non-CLRA sparing), <em>P</em> &lt; .001. A third of patients improved in VA in both groups, 27% of patients gained more than 2 lines of vision in the CLRA-sparing group and 36% in the non-CLRA-sparing group. 17% improved to better than 20/200 in CLRA-sparing and 4% in non-CLRA sparing. Overall, 11% developed neovascularization all in non-CLRA sparing. In a multiple linear regression, VA at presentation was associated with regaining vision of 2 lines or more (OR = 2.603, <em>P</em> = .007). OCT showed progressive thinning over time, reaching lowest measurements at 6 months, and stabilizing thereafter.</div></div><div><h3>Conclusions</h3><div>In this modern cohort of acute CRAO patients, presentation to a tertiary facility within 12 hours of symptoms was seen in almost half of the patients. Final VA improved in almost a third of the patients, however, vision better than the legal blindness limit was rare (∼5%). Interestingly, a third of patients had some mild elevation of systemic inflammatory markers. Better VA at presentation was associated with visual gain, while baseline OCT values had poor correlation with final outcome.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"270 ","pages":"Pages 35-51"},"PeriodicalIF":4.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonarteritic Anterior Ischemic Optic Neuropathy in Black Patients","authors":"Ana Banc ,&nbsp;George Muntean ,&nbsp;Valérie Biousse ,&nbsp;Mark J. Kupersmith ,&nbsp;Nancy J. Newman ,&nbsp;Beau B. Bruce","doi":"10.1016/j.ajo.2024.09.036","DOIUrl":"10.1016/j.ajo.2024.09.036","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Prior studies have shown that nonarteritic anterior ischemic optic neuropathy (NAION) is uncommon in persons of Black race compared with those of White race, but the reasons behind this discrepancy remain unknown. Our goal was to analyze the systemic and ocular features of Black patients with NAION compared with White patients.</div></div><div><h3>DESIGN</h3><div>Retrospective, cross-sectional study.</div></div><div><h3>METHODS</h3><div>Self-reported race was collected from all patients with NAION seen between 2014 and 2022 from a single US neuro-ophthalmology service. All Black patients with NAION and a randomly selected sample of White patients with NAION were included. We collected information on hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, obesity, ischemic heart disease, atrial fibrillation, pacemaker insertion, chronic kidney disease, dialysis, anemia, obstructive sleep apnea, deep vein thrombosis, stroke, use of phosphodiesterase inhibitors, and smoking status. We reviewed color fundus photographs and optic nerve OCT images to assess cup-to-disc ratio and document the presence of optic disc drusen. Counterfactual random forest was used to estimate associations for each characteristic of interest by race controlling for the other exposures.</div></div><div><h3>RESULTS</h3><div>We included 32 Black patients with NAION (mean age 57 ± 11 years, 38% men) and 69 of 432 White patients (mean age 57 ± 15 years, 59% men). Time between NAION onset and neuro-ophthalmic examination was significantly longer in Black patients (1.5 to &lt;3 months: odds ratio [OR], 4.07, <em>P</em> = .03; 6 to &lt;12 months: OR, 6.05, <em>P</em> = .007). Chronic kidney disease (OR, 7.53, <em>P</em> = .003) and hemodialysis (OR, 13.69, <em>P</em> = .02) were significantly more frequent in Black patients. No significant differences in cup-to-disc ratio were present (0.15 to &lt;0.25: OR, 2.83, <em>P</em> = .09; 0.25 to &lt;0.35: OR, 0.56, <em>P</em> = .46; ≥0.35: OR, 0.66, <em>P</em> = .44).</div></div><div><h3>CONCLUSIONS</h3><div>Referral delay occurs in Black patients with NAION, likely due to its relative rarity and concern for alternate diagnoses. Black patients with NAION were substantially more likely to have chronic kidney disease and be on dialysis than White patients. Despite known racial differences in cup-to-disc ratio, we found no difference between Black and White patients with NAION, suggesting that the underlying proposed compartment mechanism is the same between races.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"270 ","pages":"Pages 192-202"},"PeriodicalIF":4.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Iridectomy in Intrascleral Intraocular Lens Fixation: Preventing Reverse Pupillary Block","authors":"Fikret Ucar ,&nbsp;Muhammed Sagdic","doi":"10.1016/j.ajo.2024.10.005","DOIUrl":"10.1016/j.ajo.2024.10.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare clinical outcomes, reverse pupillary block (RPB) findings, and anterior segment parameters in patients with and without intraoperative peripheral iridectomy during sutureless flattened flange intrascleral intraocular lens (IOL) fixation.</div></div><div><h3>Design</h3><div>Retrospective comparative case series.</div></div><div><h3>Participants</h3><div>This study included 94 eyes of 82 patients who underwent IOL explantation due to vitreous-dislocated IOL at our clinic between March 2020 and September 2023, followed by flattened haptic-tipped IOL intrascleral fixation combined with pars plana vitrectomy. The patients were divided into two groups: Group 1 (<em>n</em> = 54) underwent peripheral iridectomy during surgery, while Group 2 (<em>n</em> = 40) did not undergo surgical peripheral iridectomy. Anterior chamber depth (ACD), anterior chamber angle (ACA), and white-to-white distance were measured with Scheimpflug imaging.</div></div><div><h3>Main outcomes</h3><div>Visual outcomes, ACD, ACA, spherical equivalent (SE), intraocular pressure (IOP), complications, and secondary interventions were evaluated.</div></div><div><h3>Results</h3><div>There was no significant difference between the two groups preoperatively in terms of IOP, ACD, ACA, white-to-white distance, and axial length (<em>P</em> &gt; .05). Postoperatively, the mean ACD was significantly less in Group 1 (3.79 ± 0.67 mm) than in Group 2 (4.11 ± 0.75 mm) (<em>P</em> = .03). Postoperative IOP was 15.51 ± 2.48 mm Hg in group 1 and 18.20 ± 4.51 mm Hg in group 2 (<em>P</em> &lt; .001). The postoperative ACA was statistically significantly shallower in Group 1 (41.72 ± 3.47 degrees) than in Group 2 (52.45 ± 17.93 degrees) (<em>P</em> &lt; .001). Postoperatively, RPB developed in 10 eyes (25.0%) in Group 2, while it was not observed in any patient in Group 1 (<em>P</em> &lt; .001). In Group 2, pupillary capture developed in 4 cases (10%) in addition to RPB. Laser peripheral iridotomy (LPI) was performed in cases with RPB. After LPI, mean IOP, mean ACA, and ACD also decreased significantly (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Intraoperative peripheral iridectomy during scleral fixation surgery combined with pars plana vitrectomy leads to significantly less RPB, a more stable anterior chamber, and fewer complications. LPI was very useful in managing RPB that developed in the postoperative period.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"269 ","pages":"Pages 471-481"},"PeriodicalIF":4.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142431118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Cell RNA Profiling of Ocular Adnexal Sebaceous Carcinoma Reveals a Complex Tumor Microenvironment and Identifies New Biomarkers","authors":"Michelle G. Zhang ,&nbsp;Ryan A. Gallo ,&nbsp;Charissa H. Tan ,&nbsp;Matthew Camacho ,&nbsp;Sohaib Fasih-Ahmad ,&nbsp;Acadia H.M. Moeyersoms ,&nbsp;Yoseph Sayegh ,&nbsp;Sander R. Dubovy ,&nbsp;Daniel Pelaez ,&nbsp;Andrew J. Rong","doi":"10.1016/j.ajo.2024.10.001","DOIUrl":"10.1016/j.ajo.2024.10.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Ocular adnexal sebaceous carcinoma (OaSC) is an aggressive malignancy that often necessitates orbital exenteration. Its tumor composition and transcriptional profile remain largely unknown, which poses a significant barrier to medical advances. Here, we report the first in-depth transcriptomic analysis of OaSC at the single-cell resolution and discern mechanisms underlying cancer progression for the discovery of potential globe-sparing immunotherapies, targeted therapies, and biomarkers to guide clinical management.</div></div><div><h3>Design</h3><div>Laboratory investigation with a retrospective observational case series.</div></div><div><h3>Methods</h3><div>Single-cell RNA sequencing was performed on six patient specimens: three primary tumors, two tumors with pagetoid spread, and a normal tarsus sample. Cellular components were identified via gene signatures. Molecular pathways underlying tumorigenesis and pagetoid spread were discerned via gene ontology analysis of the differentially expressed genes between specimens. CALML5 immunohistochemistry was performed on an archival cohort of OaSC, squamous cell carcinoma, ocular surface squamous neoplasia (OSSN), and basal cell carcinoma cases.</div></div><div><h3>Results</h3><div>Analysis of 29,219 cells from OaSC specimens revealed tumor, immune, and stromal cells. Tumor-infiltrating immune cells include a diversity of cell types, including exhausted T-cell populations. In primary OaSC tumors, mitotic nuclear division and oxidative phosphorylation pathways are upregulated, while lipid biosynthesis and metabolism pathways are downregulated. Epithelial tissue migration pathways are upregulated in tumor cells undergoing pagetoid spread. Single-cell RNA sequencing analyses also revealed that CALML5 is upregulated in OaSC tumor cells. Diffuse nuclear and cytoplasmic CALML5 staining was present in 28 of 28 (100%) OaSC cases. Diffuse nuclear and membranous CALML5 staining was present in 5 of 25 (20%) squamous cell carcinoma and OSSN cases, while diffuse nuclear staining was present in 1 of 12 (8%) basal cell carcinoma cases.</div></div><div><h3>Conclusions</h3><div>This study reveals a complex OaSC tumor microenvironment and confirms that the CALML5 immunohistochemical stain is a sensitive diagnostic marker.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"270 ","pages":"Pages 8-18"},"PeriodicalIF":4.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Disparities in Microinvasive Glaucoma Surgery for Management of Primary Open-Angle Glaucoma: A Propensity-Matched Cohort Study.","authors":"Pranav Vasu, Rigel P Hall, Isabella V Wagner, P Connor Lentz, Yazan Abubaker, Aya Shokair, Nithya Boopathiraj, Ibrahim Qozat, Darby D Miller, Syril Dorairaj","doi":"10.1016/j.ajo.2024.10.006","DOIUrl":"10.1016/j.ajo.2024.10.006","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate racial and ethnic differences in the use of microinvasive glaucoma surgery (MIGS) for the management of mild-moderate primary open-angle glaucoma (POAG) in the United States.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Participants: </strong>Patients with a diagnosis of mild or moderate POAG, as defined by Current Procedural Terminology (CPT) codes, were included. The experimental group comprised African American (AA) patients, and the control group consisted of patients without an AA designation in the TriNetX database.</p><p><strong>Methods: </strong>Propensity scoring was used to match cohorts for age at diagnosis, Charlson Comorbidity Index, sex, nicotine dependence, glaucoma medications, family history of POAG, body mass index, and weight. Outcome was incidence of MIGS over 1 year of follow-up. Odds ratios were calculated between cohorts.</p><p><strong>Main outcome measure: </strong>Incidence of MIGS over 1 year of follow-up post-POAG diagnosis.</p><p><strong>Results: </strong>A total of 63,418 POAG patients were included (50% AA, 50% non-AA). AA patients were found to undergo MIGS at a significantly lower rate (1,268 of 31,709) compared with non-AA patients (1,508 of 31,709) (odds ratio 0.834, 95% CI 0.773-0.900).</p><p><strong>Conclusion: </strong>Although POAG is understood to be more prevalent among African Americans, these patients display lower use of MIGS, suggesting a possible nationwide racial disparity in the management of POAG.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"96-103"},"PeriodicalIF":4.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single- Versus Triple-Agent Intra-Arterial Chemotherapy for Retinoblastoma","authors":"NAJAH O. ALSHAHRANI ,&nbsp;ABEER ALDHAWI ,&nbsp;ZHAO XUN FENG ,&nbsp;KELVIN CHAU ,&nbsp;ASHWIN MALLIPATNA ,&nbsp;PRAKASH MUTHUSAMI ,&nbsp;CARMEN PARRA-FARINAS ,&nbsp;CHRISTIAN ZAAROUR ,&nbsp;FURQAN SHAIKH ,&nbsp;BRENDA L. GALLIE ,&nbsp;STEPHANIE N. KLETKE","doi":"10.1016/j.ajo.2024.09.037","DOIUrl":"10.1016/j.ajo.2024.09.037","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the ocular and systemic outcomes of single- (melphalan) versus triple-agent (melphalan, topotecan, carboplatin) intra-arterial chemotherapy (IAC) for retinoblastoma (RB) eye salvage.</div></div><div><h3>Design</h3><div>Retrospective single-institutional clinical cohort study.</div></div><div><h3>Methods</h3><div>Children &lt;18 years with RB who underwent one or more IAC procedures between 2016 and 2024 with minimum 6-month follow-up were reviewed. Data included clinical features, IAC procedural details, additional eye-saving treatments, complications, and follow-up. Primary outcomes included ocular and systemic complications of IAC, intraocular recurrence, extraocular extension, metastasis, and death. Secondary outcomes were tumor response, ocular survival, and recurrence-free ocular survival. Comparative analysis was performed for single- versus triple-agent groups. A SWIMMER^rb plot graphically illustrated additional treatments following IAC.</div></div><div><h3>Results</h3><div>Thirty-eight eyes of 37 children (24 unilateral RB) were reviewed. Two eyes (2 children) had single- followed by multi-agent IAC and were excluded. Of 35 included children, one had bilateral triple-agent IAC. IAC (median, 3 doses; range, 1-4) was employed as primary (<em>n</em> = 21 eyes) or secondary (<em>n</em> = 15 eyes) treatment. Chemotherapy was single-agent in 13 eyes and triple-agent in 23 eyes. Following IAC, 25 eyes required additional eye-saving treatments (69% single- <em>v</em> 70% triple-agent, <em>P</em> = .983). At final follow-up, the triple-agent group was more likely to achieve very good partial or complete tumor response (91% <em>v</em> 62%, <em>P</em> = .030). Two-year recurrence-free ocular survival was 63.3% (95% CI 45.7-80.9), similar for both groups (<em>P</em> = .700). Globe salvage was 72%. Two-year ocular survival was 72.2% (95% CI 57.2-87.2), higher for the triple-agent group (82.6% <em>v</em> 53.8%; <em>P</em> = .059). Ocular complications occurred in 31% of eyes in the single- and 52% of eyes in the triple-agent group (<em>P</em> = .215). The rate of systemic complications was 38% versus 74% in the single- versus triple-agent groups, respectively (<em>P</em> = .036). No extraocular extension, metastasis, or death were observed at median 34.2 months (range, 14.5-87.0) follow-up.</div></div><div><h3>Conclusions</h3><div>Triple-agent IAC was associated with improved RB tumor response and ocular survival, though similar recurrence-free ocular survival compared to single-agent. While there were more complications with triple-agent IAC, most were mild or transient.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"269 ","pages":"Pages 488-496"},"PeriodicalIF":4.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142431117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Eyelid Cutaneous Horns: A Case Series and Literature Review","authors":"RAMEZ BARBARA ,&nbsp;AHMED M. ABDELAAL ,&nbsp;REBECCA LEVY ,&nbsp;ANITA NAGY ,&nbsp;KAMIAR MIRESKANDARI ,&nbsp;ASIM ALI","doi":"10.1016/j.ajo.2024.09.034","DOIUrl":"10.1016/j.ajo.2024.09.034","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe the clinical and histopathologic features of pediatric eyelid cutaneous horns.</div></div><div><h3>Design</h3><div>Retrospective observational case series and review of literature.</div></div><div><h3>Subjects</h3><div>Five pediatric patients with eyelid cutaneous horns.</div></div><div><h3>Methods</h3><div>Five cases with eyelid cutaneous horns were retrospectively identified using departmental databases. Patients’ records were analyzed for demographic data, clinical appearance, histologic findings, and clinical course. An excisional biopsy of the lesion was performed in 3 patients. The remaining 2 patients were managed conservatively.</div></div><div><h3>Main outcome measures</h3><div>Clinical outcome and histopathologic evaluation with emphasis on excluding malignancy.</div></div><div><h3>Results</h3><div>All 5 cutaneous horn lesions resolved surgically or conservatively. The average age at presentation was 6.6 years (range 5-11 years). Clinically, 4 lesions were preceded by a hordeolum or chalazion and all excised lesions had benign features on histologic examination. Mitotic figures or atypia were not observed. None of the patients developed recurrence during the follow-up period ranging from 1 to 96 months.</div><div>Five previous reports of five cases were found on review of the literature. Our case series doubles this number to support the benign nature of these lesions in children.</div></div><div><h3>Conclusions</h3><div>Pediatric eyelid cutaneous horns are closely related to eyelid margin inflammatory disease and appear to follow a benign course. This contrasts with the adult population where cutaneous horns are frequently associated with neoplasia.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"269 ","pages":"Pages 482-487"},"PeriodicalIF":4.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous Lower Eyelid Retractor Release Averts Lower Lid Malposition After Inferior Rectus Muscle Recession","authors":"WEI-YU LAI ,&nbsp;JOSEPH L. DEMER","doi":"10.1016/j.ajo.2024.09.030","DOIUrl":"10.1016/j.ajo.2024.09.030","url":null,"abstract":"<div><h3>Introduction</h3><div>The lower eyelid is anatomically coupled to the inferior rectus (IR) muscle, so that IR recession alone causes lower lid retraction often symptomatic due to corneal exposure. Although procedures within the conjunctival incision reduce retraction slightly, cutaneous lower eyelid retractor release (CLERR) eliminates this problem.</div></div><div><h3>Design</h3><div>Retrospective comparative interventional case series.</div></div><div><h3>Methods</h3><div>We reviewed 89 consecutive IR recessions performed by one surgeon between September 2019 and May 2024, of which 71 included CLERR performed after local anesthetic infiltration in 2-3 minutes by dissection of the retractors from the inferior margin of the tarsus via skin incision over the lateral orbital rim, using scissors blades visualized through the intact inferior tarsal conjunctiva. Inferior scleral show was measured an average of 116 days postoperatively.</div></div><div><h3>Results</h3><div>Although mean IR recession was greater at 4.6 ± 1.8 mm (standard deviation, range 2-8 mm) with CLERR than 3.2 ± 1.2 mm (range 2-6 mm) without it (<em>P</em> = .003), inferior scleral show averaged less with CLERR at 0.2 ± 0.9 mm than 0.7 ± 1.0 mm without it (<em>P</em> = .043). The procedure was also effective in thyroid ophthalmopathy. Lower lid ecchymosis occurred in 22 (31%) cases with CLERR, but resolved within one week without patient complaints. The skin incision healed without visible scar in 5-7 days. There was one complication of severing an IR hangback suture that was repaired during suture adjustment.</div></div><div><h3>Conclusion/Relevance</h3><div>CLERR is a quick and simple procedure that virtually eliminates lower eyelid retraction following IR recession of any amount, avoiding inferior scleral show and new dry eye symptoms without additional conjunctival dissection. It is a quick oculoplastic procedure readily performed by any strabismus surgeon.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"269 ","pages":"Pages 466-470"},"PeriodicalIF":4.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}