1
|
Cale M, Roelofs KA, Goldberg RA, Leibowitz S, Glasgow BJ, Rootman DB. Hyperostosis associated with orbital vascular malformation. Orbit 2024; 43:236-239. [PMID: 35850633 DOI: 10.1080/01676830.2022.2101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
Abstract
A previously healthy adult male presented with a slowly enlarging orbital mass associated with 5 mm of non-pulsatile proptosis. On imaging, a soft tissue lesion with avid contrast enhancement and associated bony hyperostosis was noted. The lesion and hyperostotic bone were surgically debulked, and significant arterial bleeding was noted intraoperatively consistent with an arteriovenous malformation. Histopathologic analysis revealed a vascular malformation with enhanced microvasculature infiltrating the periosteum. While vascular lesions elsewhere in the body can be associated with skeletal changes, bony hyperostosis is a rare feature of orbital vascular malformations.
Collapse
Affiliation(s)
- Mario Cale
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Steven Leibowitz
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Ben J Glasgow
- Departments of Ophthalmology and Pathology and Laboratory Medicine, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| |
Collapse
|
2
|
Goodyear K, Roelofs KA, Chen AC, Goldberg RA. Visual Outcomes Following Surgical Debulking in Exophytic Optic Nerve Sheath Meningiomas. Ophthalmic Plast Reconstr Surg 2024; 40:150-155. [PMID: 37615287 DOI: 10.1097/iop.0000000000002497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PURPOSE To report a case of a globular primary optic nerve sheath meningioma managed surgically with improvement in vision and review the literature for outcomes of purely intraorbital exophytic-globular primary optic nerve sheath meningiomas managed surgically. METHODS A literature review was conducted using Google Scholar and PubMed with the search terms "primary optic nerve sheath meningioma," "surgery," "exophytic," and "globular." Articles were included if they were available in English. Individual cases from the reviewed articles were included if the tumor was purely intraorbital with a globular or exophytic morphology, was managed with total or subtotal surgical excision, and visual outcomes were reported. Cases were excluded if the tumor extended intracanalicularly or intracranially, tumor morphology was unknown, or surgical management consisted of biopsy, optic nerve sheath decompression, or optic canal decompression rather than tumor debulking. RESULTS A total of 28 patients with intraorbital globular-exophytic primary optic nerve sheath meningiomas managed surgically have been reported in the literature. Vision improved in 29% (n = 8/28) and remained stable in 43% (n = 12/28) of patients. Furthermore, patients with good (Snellen notation ≥ 0.5) vision (n = 10) typically retained good vision postoperatively and at follow-up, with 1 patient experiencing a decline to poor (Snellen ≤0.1) vision at the last follow-up (92 months postoperatively). Similarly, patients with fair (Snellen notation >0.1 and <0.5) vision (n = 5) often improved to good vision (n = 3) or stayed at fair vision (n = 1), with 1 declining to poor vision at postoperative hospital discharge. CONCLUSIONS Surgical management of exophytic or globular optic nerve meningiomas does not universally lead to vision loss and may be appropriate in select patients.
Collapse
Affiliation(s)
- Kendall Goodyear
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | | | | | | |
Collapse
|
3
|
Goodyear K, Roelofs KA, Su-Velez BM, Cohen LM, Vadehra K, Beswick DM, Rootman DB. A Minimally Invasive Endoscopic Transnasal and Transorbital Approach to Sinonasal Tumor Resection. Laryngoscope 2024; 134:1308-1312. [PMID: 37606271 DOI: 10.1002/lary.30960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
A 35-year-old female with an extensive biphenotypic sinonasal sarcoma (BSNS) eroding through the left frontal sinus into the orbit required gross total resection of the tumor. We wanted to forgo an open approach and provide a less invasive alternative via combined endonasal and transorbital endoscopic techniques to allow for tumor removal through small, well-disguised incisions. We utilized three portals-nasal, transorbital, and anterior table window-to create interconnected orbit-sinonasal corridors, thus generating alternate pathways for visualization and manipulation of this extensive tumor. Laryngoscope, 134:1308-1312, 2024.
Collapse
Affiliation(s)
- Kendall Goodyear
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Brooke M Su-Velez
- Department of Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kumkum Vadehra
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, California, U.S.A
| | - Daniel M Beswick
- Department of Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| |
Collapse
|
4
|
Osias EA, Roelofs KA, Leibowitz S, Goldberg RA, Rootman DB. Transorbital Endoscopic Approach to the Pterygopalatine Fossa: A Less Invasive Alternative to Traditional Access. Ophthalmic Plast Reconstr Surg 2024; 40:223-226. [PMID: 37995150 DOI: 10.1097/iop.0000000000002546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE The purpose of this article and accompanying video is to demonstrate a transorbital endoscopic approach for accessing the pterygopalatine fossa (PPF). This technique does not require a skin incision, avoids dissection of critical neurovascular structures, and utilizes a comparatively small osteotomy. The 2 cases presented in this article highlight the utility of a transorbital endoscopic approach for accessing an anatomic region that has traditionally required more invasive techniques to reach. METHODS Description of surgical technique with 2 illustrative clinical cases and accompanying surgical video. RESULTS Surgical technique: A trans-conjunctival approach is taken to the inferior orbital rim, and a subperiosteal dissection is propagated posteriorly. The bone of the posterior orbital floor is then deroofed, and the superior portion of the posterior wall of the maxillary sinus is removed, allowing access to the PPF for an incisional biopsy. CASE A 76-year-old male with a history of left cheek squamous cell carcinoma presented with progressive V2 paresthesia and an abnormally enhancing lesion in the left PPF on MRI. CASE A 58-year-old male with no significant medical history presented with left facial numbness (V1-V3), ptosis, an abduction deficit, and decreased hearing. Contrast-enhanced MRI demonstrated an abnormally enhanced lesion in the left PPF extending to Meckel's cave.The transorbital approach described was used to successfully obtain a diagnostic biopsy in both cases. CONCLUSIONS These cases highlight the utility of a transorbital endoscopic approach to the PPF as a less morbid alternative to traditional access. Patient selection is key to identifying appropriate cases.
Collapse
Affiliation(s)
- Ethan A Osias
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | | | | | | | | |
Collapse
|
5
|
Gundlach BS, Roelofs KA, Rootman DB. Inferior Oblique Flap: An Approach for Improved Vascular Supply in Complex Ocular Surface Reconstruction. Ophthalmic Plast Reconstr Surg 2024; 40:e56-e58. [PMID: 38215453 DOI: 10.1097/iop.0000000000002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
This case report describes a novel surgical technique using an inferior oblique muscle flap for a patient requiring complex ocular surface reconstruction. A 63-year-old female with Stevens-Johnson syndrome and complex ocular history including multiple penetrating keratoplasties and keratoprostheses presented with recurrent keratoprosthesis implant plate necrosis. In conjunction with revision keratoplasty, a custom inferior oblique muscle flap was designed to provide improved support and vascularity to the corneal tissue bed; at 12 months postoperation, the graft remained well attached and free of graft failure. Here, we present this technique along with operative photos, describing how this technique may provide surgeons an additional option for complex ocular surface reconstruction.
Collapse
Affiliation(s)
- Bradley S Gundlach
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | | | | |
Collapse
|
6
|
Oh AJ, Sears CM, Vadivelan AA, Gomperts BN, Federman N, Said J, Roelofs KA. Orbital indeterminate cell histiocytosis. Orbit 2024:1-5. [PMID: 38374584 DOI: 10.1080/01676830.2024.2317301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
An 8-year-old female presented to the oculoplastics clinic with 3 months of left upper eyelid fullness and edema. Examination showed a mass in the left anterior superior orbit with erythema. Imaging demonstrated a well-circumscribed superolateral orbital mass that was T1 hypointense and T2 hypo-to-iso intense with contrast enhancement. An incisional biopsy was performed via an upper lid crease incision. Histopathology showed aggregates of histiocytic cells with fibrosis and infiltration of eosinophils. Immunohistochemistry revealed positive CD68 and CD163 staining and negative langerin staining, confirming the diagnosis of indeterminate cell histiocytosis. There was no systemic involvement or associated dermatologic findings. Repeat exam 3 months later showed no change in the size of the lesion and the patient was referred to hematology-oncology for treatment. On most recent exam, the patient had no new symptoms or side effects following 3 months of oral hydroxyurea (25 mg/kg/day). Repeat orbital imaging showed no progression of the lesion and the patient will be monitored closely. Here, we report a rare case of isolated orbital indeterminate cell histiocytosis in a young child.
Collapse
Affiliation(s)
- Angela J Oh
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Connie M Sears
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Akhila A Vadivelan
- Department of Pediatrics, Division of Hematology/Oncology, University of California, Los Angeles, California, USA
| | - Brigitte N Gomperts
- Department of Pediatrics, Division of Hematology/Oncology, University of California, Los Angeles, California, USA
| | - Noah Federman
- Department of Pediatrics, Division of Hematology/Oncology, University of California, Los Angeles, California, USA
| | - Jonathan Said
- Department of Anatomic Pathology, University of California, Los Angeles, California, USA
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| |
Collapse
|
7
|
Goodyear K, Ghiam S, Strawbridge J, Oh AJ, Singh P, Roelofs KA, Rootman DB. Prevalence, Clinical and Imaging Characteristics of Superior Ophthalmic Vein Periphlebitis in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00327. [PMID: 38285960 DOI: 10.1097/iop.0000000000002592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
INTRODUCTION To determine the prevalence, clinical features, and radiographic findings of superior ophthalmic vein periphlebitis (SOVP) in thyroid eye disease (TED). METHODS Patients with a clinical diagnosis of thyroid eye disease and contrast-enhanced imaging were included. Imaging was reviewed for the presence of SOVP, and patients with SOVP were compared to those without. A random eye was determined to be the affected eye in patients without SOVP. RESULTS A total of 212 patients met the inclusion criteria. Unilateral SOVP was identified in 4.7% of cases. There was no significant difference in age (p = 0.22), gender (p = 0.09), or disease duration (p = 0.14) between patients with and without SOVP. There was a significant (p < 0.05) difference in stage classification and clinical activity core between the groups. The affected eye in patients with SOVP had significantly (p < 0.05) greater margin reflex distance 1, degree of relative proptosis, horizontal motility restriction, and vertical motility restriction than in patients without SOVP. There was no significant difference in horizontal strabismus (p = 1.0), vertical strabismus (p = 0.87), or relative intraocular pressure (p = 0.77). On imaging, the maximal diameter of the SR and IR were found to be significantly (p < 0.05) larger in the affected eye of patients with periphlebitis; however, there was no difference in measured diameter of the medial rectus and (p = 0.30) or lateral rectus (p = 0.78). CONCLUSIONS SOVP is an under-reported imaging finding of thyroid eye disease. It is associated with significantly greater margin reflex distance 1, relative proptosis, and motility restriction on exam as well as larger superior rectus and inferior rectus diameter on imaging. These patients tend to present in the active stage of disease with greater clinical activity score.
Collapse
Affiliation(s)
- Kendall Goodyear
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Sean Ghiam
- Department of Ophthalmology, Sackler School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv, Israel
| | - Jason Strawbridge
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
| | - Angela J Oh
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Pallavi Singh
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| |
Collapse
|
8
|
Roelofs KA, Juniat V, O'Rouke M, Ledbetter L, Hubschman S, Hardy T, Lee J, Baugh S, Pullarkat ST, Selva D, Goldberg RA, Rootman DB. Radiologic Features of Well-circumscribed Orbital Tumors With Histopathologic Correlation: A Multi-center Study. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00313. [PMID: 38215460 DOI: 10.1097/iop.0000000000002584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE To delineate specific imaging characteristics of solitary fibrous tumors, schwannomas, cavernous venous malformations, and well-circumscribed orbital lymphoma. METHODS Patients undergoing excisional biopsy of solitary fibrous tumor, schwannomas, cavernous venous malformations, or well-circumscribed orbital lymphoma with preoperative MRIs available for review were identified at 3 academic centers in the United States and Australia. An exploratory statistical analysis was performed to identify important radiologic features, which were subsequently included in a random forest model. Histopathologic correlates were evaluated in representative cases. RESULTS A total of 91 cases were included with a mean age of 52.9 ± 17.2 years. Nearly all solitary fibrous tumors were located in the anterior or mid orbit (87.5%) and they more commonly demonstrated intralesional heterogeneity on T2-weighted imaging (45.5%) (p < 0.01). Compared with the other tumors, schwannomas tended to be intraconal (66.7%) and were often in the mid or posterior orbit (83.4%) (p < 0.01). Cavernous venous malformations characteristically demonstrated progressive contrast enhancement (93.9%; p < 0.01). Most lesions in all 4 groups were hypointense on T1-weighted imaging (80%-100%; p = 0.14) and only well-circumscribed orbital lymphoma tended to also be hypointense on T2 (81.8%) (p < 0.01). Finally, cases of lymphoma had significantly lower apparent diffusion coefficient ratios (0.9 ± 0.2) (p < 0.001), while the other 3 groups were not significantly different from one another (cavernous venous malformations: 1.8 ± 0.4; schwannomas: 1.8 ± 0.5; and solitary fibrous tumor: 1.6 ± 0.6) (p = 0.739). CONCLUSIONS Key features that aid in the differentiation of these 4 tumors from one another include T2 intensity and homogeneity, early contrast-enhancement pattern, and ADC ratio.
Collapse
Affiliation(s)
- Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Valerie Juniat
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael O'Rouke
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Luke Ledbetter
- Department of Radiology, University of California, Los Angeles, California, U.S.A
| | - Sasha Hubschman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Thomas Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Jean Lee
- Department of Medical Imaging, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Sheeja T Pullarkat
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| |
Collapse
|
9
|
Chen T, Roelofs KA, Baugh S, Esfandiari M, Rootman DB. Orbital Liposarcoma: A Surveillance, Epidemiology and End Results Database Study. Ophthalmic Plast Reconstr Surg 2024; 40:93-98. [PMID: 37695202 DOI: 10.1097/iop.0000000000002516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
PURPOSE Orbital liposarcoma is a challenging tumor to treat due to its rarity and high rate of local recurrence, and the role of radiotherapy and chemotherapy remain unclear. Analysis of big data may improve our overall understanding of orbital disease and role of adjuvant therapies. METHODS Data were extracted from the Surveillance, Epidemiology and End Results (SEER) Research Plus database from 1975 to 2017. All patients with a diagnosis of liposarcoma (ICD-O3 codes 8850-8858, 8869-8862, 8870, 8880, 8881) were included. Cases were divided into 4 groups by primary site: orbit, retroperitoneum, soft tissue, and other. RESULTS A total of 16,958 patients were included. Patients with orbital involvement were younger and more likely to be female ( p < 0.05). Among orbital lesions, myxoid liposarcoma was the most common histologic subtype (6/19; 31.6%) followed by well differentiated (5/19; 26.3%). This differed from the distribution of histologic subtypes encountered elsewhere, for which well-differentiated liposarcoma was the most common (retroperitoneum 979/3,136; 31%, soft tissue 3,493/11,671; 30%, and other sites 497/2,132; 23%, p < 0.05). Dedifferentiated histologic subtype was the second most common subtype found in the retroperitoneum (946/3,136; 30%), whereas it was less common in the orbit (2/19; 11%) and soft tissue (1,396/11,671; 12%) ( p < 0.001). Patients with orbital liposarcoma had similar disease-specific mortality compared with soft-tissue location ( p = 0.825) and lower disease-specific mortality compared with retroperitoneal location ( p < 0.001). When all locations were combined, patients with well-differentiated liposarcoma had the lowest disease-specific mortality. CONCLUSIONS Patients with orbital liposarcoma tend to be younger, female, and have a better prognosis than those with retroperitoneal disease, likely due to the lower incidence of dedifferentiated histologic subtype.
Collapse
Affiliation(s)
- Teresa Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Samuel Baugh
- Department of Statistics, University of California, Los Angeles, California, U.S.A
| | - Mahtash Esfandiari
- Department of Statistics, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| |
Collapse
|
10
|
Strawbridge JC, Roelofs KA, Naderi J, Goh TY, Rootman DB. Orbital manifestations of B-cell acute lymphoblastic leukemia/lymphoma. Orbit 2023; 42:654-658. [PMID: 35580237 DOI: 10.1080/01676830.2022.2072901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
A 2-year-old boy presented with left periorbital edema, proptosis, hyperglobus and esotropia. Imaging revealed an inferotemporal orbital mass with adjacent bony erosion. Histological evaluation of an orbital biopsy revealed B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/BLL). The patient was subsequently treated with chemotherapy. Although orbital involvement in acute myelogenous leukemia has been well-described, orbital manifestations of B-ALL/BLL are uncommon, with only a limited number of previous reports in the literature.
Collapse
Affiliation(s)
- Jason C Strawbridge
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelsey A Roelofs
- Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
| | - Jason Naderi
- Rosalind Franklin University School of Medicine, North Chicago, Illinois, USA
| | - Tracie Y Goh
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
| |
Collapse
|
11
|
Cheng S, Roelofs KA, Pirakitikulr N, Rootman DB. Orbital Vascular Malformations: Relationship Between Enophthalmos and Clinically Apparent Distensibility with Valsalva. Ophthalmic Plast Reconstr Surg 2023; 39:487-491. [PMID: 36972118 DOI: 10.1097/iop.0000000000002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE Determining the hemodynamic characteristics of an orbital vascular malformation is a critical step in management. The purpose of this study is to assess the relationship between enophthalmos and clinically apparent distensibility of orbital vascular malformations, to optimize imaging and treatment. METHODS In this cross-sectional cohort study consecutive patients at a single institution were screened for study entry. Data extracted included age, sex, Hertel measurements, presence or absence of distensibility during the Valsalva maneuver, whether lesions were primarily venous or lymphatic based on imaging, and location of the lesion relative to the globe. Enophthalmos was defined as ≥ 2 mm difference from the opposite side. Parametric and nonparametric statistics were used, and linear regression was performed to examine factors predictive of Hertel measurement. RESULTS Twenty-nine patients met the inclusion criteria. Relative enophthalmos ≥2 mm was significantly associated with distensibility ( p = 0.03; odds ratio = 5.33). Distensibility and venous dominant morphology were the 2 most important factors associated with enophthalmos on regression analysis. The relative position of the lesion anterior or posterior to the globe did not have a significant bearing on baseline enophthalmos. CONCLUSIONS The presence of enophthalmos increases the likelihood that an orbital vascular malformation is distensible. This group of patients was also more likely to be characterized by venous dominant malformations. Baseline clinical enophthalmos may serve as a useful surrogate marker for distensibility and venous dominance, which may be useful in guiding the selection of appropriate imaging.
Collapse
Affiliation(s)
- Sarah Cheng
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | | | | | | |
Collapse
|
12
|
Chen TH, Roelofs KA, Goh T, Pullarkat S, Goldberg RA, Rootman DB. Orbital Involvement in Acute Adult Leukemias: Case Series and Review of Literature. Ophthalmic Plast Reconstr Surg 2023; 39:e107-e111. [PMID: 37083726 DOI: 10.1097/iop.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Orbital involvement in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) is well-described in children but is uncommon in adults. This series reports 2 adult patients with orbital leukemic involvement and summarizes the existing literature. A 37-year-old male with recently diagnosed AML underwent induction therapy and subsequently developed a tan-pink colored sub-conjunctival lesion in the left eye. Incisional biopsy confirmed AML. A 35-year-old male with history of ALL presented with left-sided orbital mass. Fine needle aspiration biopsy confirmed ALL. Literature review of adult-onset orbital leukemia yielded 29 cases of AML and 3 cases of ALL. Orbital involvement of acute adult-onset leukemia tends to be unilateral, presents in the extraconal space and can occur at any point during systemic leukemic disease. Chemotherapy is the mainstay of treatment, often in combination with radiation and/or hematopoietic stem cell transplant.
Collapse
Affiliation(s)
- Teresa H Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Tracie Goh
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Sheeja Pullarkat
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| |
Collapse
|
13
|
Goodyear K, Roelofs KA, Goldberg RA. Banking Autologous Tarsus: A Simple Technique for Maximizing Preservation of Healthy Tissue. Ophthalmic Plast Reconstr Surg 2023; 39:e82-e84. [PMID: 36877562 DOI: 10.1097/iop.0000000000002339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
A 28-year-old female with congenital left-sided ptosis presented after 3 prior surgeries elsewhere. Although centrally her margin to reflex distance1 was 3 mm, persistent ptosis was noted laterally. In an effort to improve the symmetry of her eyelid contour, a lateral tarsectomy was performed. As the authors worried this might worsen her dryness, the decision was made to bank the excised tarso-conjunctival tissue in case additional revision surgery is required at a later date. To accomplish this, a conjunctival incision was created at the inferior tarsal margin in the ipsilateral lower lateral eyelid and the excised upper eyelid tarso-conjunctival tissue was secured in this pocket. Four months postoperatively, the banked tissue appeared healthy and the upper eyelid contour was improved. This technique may be most helpful in multi-operated situations, where the chance of future revision is not insignificant.
Collapse
Affiliation(s)
- Kendall Goodyear
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | | | | |
Collapse
|
14
|
O'Day RFJ, Roelofs KA, Negretti GS, Hay G, Arora AK, Stoker I, Damato BE, Sagoo MS, Cohen VML. Long-term visual outcomes after ruthenium plaque brachytherapy for posterior choroidal melanoma. Eye (Lond) 2023; 37:959-965. [PMID: 35140328 PMCID: PMC10050407 DOI: 10.1038/s41433-022-01944-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To assess the long-term visual outcomes in patients with posteriorly located choroidal melanoma treated with ruthenium plaque brachytherapy between January 2013 and December 2015. METHODS A retrospective review was conducted on consecutive patients treated with ruthenium plaque brachytherapy for post-equatorial choroidal melanoma with available Snellen visual acuity before and after treatment, and the development and treatment of radiation complications. RESULTS There were 219 patients with posterior choroidal melanoma treated with ruthenium plaque brachytherapy. Median follow up was 56.5 months, range 12-81 months. Final visual acuity was ≥6/12 in 97 (44.3%) patients, 6/12 to 6/60 in 57 (26.0%), <6/60 in 55 (25.1%) and 10 (4.6%) eyes were enucleated. Radiation maculopathy was the most common radiation complication encountered, occurring in 53 (24.2%) patients. Of these, final visual acuity was 6/12 in 10 patients (18.9%), 6/12 to 6/60 in 26 (49.1%), <6/60 in 16 (30.2%) and 1 eye (1.9%) was enucleated. Twenty-five (47%) with radiation maculopathy were treated with intravitreal anti-angiogenic therapy, 27 (51%) were monitored and one (2%) was treated with scatter photocoagulation. Eyes treated with intravitreal anti-angiogenic therapy had better final vision than those observed or treated with retinal laser (chi-square, p = 0.04). On multivariate analysis, close proximity to the optic nerve and fovea, and large or notched plaque type was associated with final vision worse than 6/12. CONCLUSION Most patients treated with ruthenium plaque brachytherapy for posterior choroidal melanoma retain 6/60 vision, with almost half retaining 6/12 vision at long term follow up.
Collapse
Affiliation(s)
- Roderick F J O'Day
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK.
- Ocular Oncology Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
| | - Kelsey A Roelofs
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, USA
| | - Guy S Negretti
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
| | - Gordon Hay
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Amit K Arora
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Ian Stoker
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
| | - Bertil E Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| |
Collapse
|
15
|
Chen T, Roelofs KA, Rootman DB. Allergic conjunctivitis and contact dermatitis following silicone tube intubation. Can J Ophthalmol 2023; 58:e36-e38. [PMID: 35868439 DOI: 10.1016/j.jcjo.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/23/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Teresa Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA.
| |
Collapse
|
16
|
Roelofs KA, Margines JB, Chen T, Goodyear K, Goldberg RA, Rootman DB. Optimizing Management of Asymmetric Ptosis: A Comparison of Three Posterior Approach Resection Algorithms. Ophthalmic Plast Reconstr Surg 2023; 39:72-75. [PMID: 36095846 DOI: 10.1097/iop.0000000000002246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to compare the efficacy of 3 resection algorithms in the management of patients with asymmetric ptosis. METHODS Patients undergoing bilateral Muller's muscle-conjunctival resection (MMCR) were identified. Standardized preoperative clinical photographs were examined and margin reflex distance 1 (MRD1) was measured using ImageJ. Patients presenting with ≥1 mm of asymmetry in MRD1 were included. Three groups were identified: variable (4:1 ratio, with the lower side receiving a greater resection), fixed (7 mm resection bilaterally), and tarsectomy (7 mm bilaterally + 1 mm of tarsus resected on the lower preoperative side). Postoperative MRD1 was measured from photographs obtained 3 months after surgery. The primary outcome was postoperative asymmetry. RESULTS A total of 95 patients with a mean age of 71.0 ± 11.0 years were included. There was no significant difference in age ( p = 0.277) or length of follow-up ( p = 0.782) between the groups. Although the fixed tarsectomy group had significantly greater preoperative asymmetry ( p = 0.001), there was no significant difference in postoperative asymmetry ( p = 0.166). On multivariate analysis, preoperative asymmetry was the only significant predictor of postoperative asymmetry ( p < 0.001). Specifically, the surgical group was not a predictor of the primary outcome ( p = 0.723). CONCLUSIONS Resection amount and technique did not predict postoperative outcomes in cases of asymmetric ptosis. This may support the hypothesis that changes in eyelid position and symmetry following MMCR is due to a dynamic system, rather than as a result of purely mechanical forces.
Collapse
Affiliation(s)
- Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, U.S.A
| | | | | | | | | | | |
Collapse
|
17
|
Lee CM, Asilnejad B, Cohen LM, Roelofs KA, Rootman DB, Khanlou N, Pullarkat ST. Solitary Extramedullary Plasmacytoma of the Lacrimal Sac With Associated Crystal-Storing Histiocytosis. Ophthalmic Plast Reconstr Surg 2022; 38:102-107. [PMID: 34406151 DOI: 10.1097/iop.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a rare case of crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma of the lacrimal sac and to review literature on the 2 entities to summarize important diagnostic, management, and prognostic considerations. METHODS A case report of the ophthalmologic presentation, pathology workup, and oncologic management is presented. Literature search with focus on lesions occurring in ophthalmic sites and management guidelines from expert panels and working groups. RESULTS Crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma arose within the lacrimal sac of a previously healthy middle-aged woman and presented as a painless nodule with epiphora. The biopsy tissue showed sheets of crystal-filled histiocytes, interspersed with monoclonal plasma cells and rarely demonstrated plasma cell phagocytosis. Imaging and laboratory studies confirmed the localized nature. CONCLUSIONS Crystal-storing histiocytosis is an uncommon entity in which crystals, most commonly arising from altered immunoglobulins, aggregate within histiocytes and form symptomatic mass lesions. It has been reported in ophthalmic regions in patients with a concurrent lymphoproliferative or plasma cell disorder and can rarely predate a malignancy. The current case is notable because crystal-storing histiocytosis occurs with a localized process, solitary extramedullary plasmacytoma, and presents in an unusual site, the lacrimal sac. Tissue biopsy with multimodal pathological evaluation is necessary to make the diagnosis. Ophthalmologists should recognize that crystal-storing histiocytosis is commonly associated with a hematologic malignancy and, when appropriate, refer the patient for oncologic management. Surveillance may be indicated in cases with no established etiology. Solitary extramedullary plasmacytoma should also be monitored, as a proportion of cases progress to multiple myeloma.
Collapse
Affiliation(s)
- Christine M Lee
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brenda Asilnejad
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Negar Khanlou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sheeja T Pullarkat
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
18
|
Flanagan JP, O'Day RF, Roelofs KA, McGuinness MB, van Wijngaarden P, Damato BE. The MOLES system to guide the management of melanocytic choroidal tumours: can optometrists apply it? Clin Exp Optom 2022; 106:271-275. [PMID: 35156536 DOI: 10.1080/08164622.2022.2029685] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Although melanocytic choroidal tumours of the choroid are a common eye pathology, no standardised protocol exists for their management in the community. BACKGROUND Choroidal naevi are found in approximately 6% of the adult White population, whereas choroidal melanomas are rare, with an annual incidence of 5-10/million/year. Multimodal imaging has advanced the understanding of malignancy imaging biomarkers, but distinguishing between a small melanoma and naevus remains difficult and an algorithm for their management by community practitioners has not been uniformly adopted. One of the authors (BD) devised the MOLES scoring system, which indicates malignancy likelihood according to mushroom shape, orange pigment, large size, enlargement, and subretinal fluid. When applied by ocular oncologists, the system accurately distinguishes choroidal naevi from melanomas. The aim of this study was to evaluate whether community optometrists can appropriately manage patients with melanocytic choroidal tumours using this system. METHODS Clinical images of 25 melanocytic choroidal tumours were presented in an online survey, including colour fundus photographs, fundus autofluorescence, optical coherence tomography, and B-scan ultrasound images. Using the MOLES system, 39 optometrists diagnosed tumours as naevus or probable melanoma and decided between community monitoring and ophthalmologist referral. Responses were compared to MOLES grading of the same clinical images by ocular oncologists. RESULTS Using MOLES, optometrists correctly identified 389/406 probable melanomas (95.8% sensitivity) and 331/516 choroidal naevi (64.1% specificity); correctly referred 773/778 tumours to an ophthalmologist (99.4% sensitivity); and correctly managed 80/144 lesions (55.6% specificity) in the community. CONCLUSION Optometrists safely applied the MOLES scoring system in this survey. Further measures are indicated to reduce choroidal naevi over-referral and evaluate MOLES system usage in clinical optometric practice, where some imaging modalities may not be readily available.
Collapse
Affiliation(s)
- Jeremy Pm Flanagan
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Roderick F O'Day
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Ocular Oncology Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Ocular Oncology Service, Moorfields Eye Hospital, London, UK
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - Myra B McGuinness
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Peter van Wijngaarden
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Bertil E Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK.,Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
19
|
Roelofs KA, Duckwiler G, Gundlach B, Yoo B, Diniz SB, Cohen LM, Goldberg RA, Rootman DB. Orbital vascular malformations: determining outflow with Valsalva CT angiography. Ophthalmology 2022; 129:590-592. [PMID: 35031439 DOI: 10.1016/j.ophtha.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
Distensible orbital vascular malformations with direct outflow to the cavernous sinus tend to show a disproportionate increase in ipsilateral superior ophthalmic vein size on Valsalva CTA and are often located closer to the apex.
Collapse
Affiliation(s)
- Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Gary Duckwiler
- Division of Interventional Neuroradiology, Department of Radiology, UCLA Medical Centre, Los Angeles, California, U.S.A
| | - Bradley Gundlach
- David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
| | - Bryan Yoo
- Division of Diagnostic Neuroradiology, Department of Radiology, UCLA Medical Centre, Los Angeles, California, U.S.A
| | - Stefania B Diniz
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A..
| |
Collapse
|
20
|
Diniz SB, Cohen LM, Roelofs KA, Rootman DB. Early Experience With the Clinical Use of Teprotumumab in a Heterogenous Thyroid Eye Disease Population. Ophthalmic Plast Reconstr Surg 2021; 37:583-591. [PMID: 33710036 DOI: 10.1097/iop.0000000000001959] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical course in a heterogeneous series of subjects with thyroid eye disease (TED) treated with teprotumumab. METHODS Cross-sectional cohort study including patients with clinical diagnosis of TED who was treated with teprotumumab. The entire cohort was analyzed together and subsequently in clinical subgroups based on stage and grade of disease. Primary outcome measure was change in proptosis ≥2 mm. Secondary outcome measures included change in clinical activity score (CAS), ductions, strabismic deviation, MRD1, and MRD2. Bivariate and multivariate statistics were performed. RESULTS The study included 21 patients. Mean ± SD age was 61.5 ± 12.6 years and 71.4% were female. Reduction in proptosis ≥2 mm was achieved in 71.4% of the sample. Stage and grade were not significant predictors of outcome. Treatment with teprotumumab resulted in a 2.5 ± 1.8 mm reduction of proptosis (P < 0.001), 2.2 ± 1.4 reduction in CAS (P < 0.001), and 16.9 ± 19.3 degree improvement in extraocular motility (P < 0.001). There were no significant differences for change in CAS, proptosis, ductions, or MRD2 between different grades and stages of disease. Total strabismus and MRD1 improvement were greater in the active stage of disease (P < 0.05). Three cases of dysthyroid optic neuropathy, refractory to methylprednisolone therapy improved after initiation of teprotumumab. CONCLUSIONS Treatment of TED with teprotumumab in a heterogeneous patient population is associated with improvement in proptosis, extraocular motility, and CAS. Patients beyond those defined in the clinical trials, including those affected by stable stage, milder grade, and vision-threatening TED may benefit from this therapy. There are, however, limits on the overall efficacy of this medication in the management of certain physical characteristics in TED including eyelid position and strabismus.
Collapse
Affiliation(s)
- Stefania B Diniz
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | | | | | | |
Collapse
|
21
|
Roelofs KA, O’Day R, Harby LA, Hay G, Arora AK, Sagoo MS, Damato B. Reply to Comment on Roelofs, K.A.; et al. "Detecting Progression of Melanocytic Choroidal Tumours by Sequential Imaging: Is Ultrasonography Necessary?" Cancers 2020, 12, 1856. Cancers (Basel) 2021; 13:1320. [PMID: 33809426 PMCID: PMC8002149 DOI: 10.3390/cancers13061320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/04/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
We thank Capasso et al [...].
Collapse
Affiliation(s)
- Kelsey A. Roelofs
- Ocular Oncology Service, Moorfields Eye Hospital, London EC1V 2PD, UK; (K.A.R.); (R.O.); (L.A.H.); (G.H.); (A.K.A.); (M.S.S.)
| | - Roderick O’Day
- Ocular Oncology Service, Moorfields Eye Hospital, London EC1V 2PD, UK; (K.A.R.); (R.O.); (L.A.H.); (G.H.); (A.K.A.); (M.S.S.)
- Department of Ophthalmology, Ocular Oncology Clinic, Royal Victorian Eye and Ear Hospital, Melbourne 3002, Australia
| | - Lamis Al Harby
- Ocular Oncology Service, Moorfields Eye Hospital, London EC1V 2PD, UK; (K.A.R.); (R.O.); (L.A.H.); (G.H.); (A.K.A.); (M.S.S.)
| | - Gordon Hay
- Ocular Oncology Service, Moorfields Eye Hospital, London EC1V 2PD, UK; (K.A.R.); (R.O.); (L.A.H.); (G.H.); (A.K.A.); (M.S.S.)
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London EC1V 9EL, UK
| | - Amit K. Arora
- Ocular Oncology Service, Moorfields Eye Hospital, London EC1V 2PD, UK; (K.A.R.); (R.O.); (L.A.H.); (G.H.); (A.K.A.); (M.S.S.)
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London EC1V 9EL, UK
| | - Mandeep S. Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London EC1V 2PD, UK; (K.A.R.); (R.O.); (L.A.H.); (G.H.); (A.K.A.); (M.S.S.)
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London EC1V 9EL, UK
| | - Bertil Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London EC1V 2PD, UK; (K.A.R.); (R.O.); (L.A.H.); (G.H.); (A.K.A.); (M.S.S.)
- Nuffield Laboratory of Ophthalmology, University of Oxford, London OX3 9DU, UK
| |
Collapse
|
22
|
Goodyear K, Roelofs KA, Rootman DB. Smart MALT: lymphoma with a superior predilection. Orbit 2021; 41:272. [PMID: 33719902 DOI: 10.1080/01676830.2021.1888304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kendall Goodyear
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, California, USA
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, California, USA
| |
Collapse
|
23
|
Negretti GS, Roelofs KA, Damato B, Sagoo M, Parvizi S, Cohen VML. The natural history of conjunctival naevi in children and adolescents. Eye (Lond) 2020; 35:2579-2584. [PMID: 33199866 PMCID: PMC7668404 DOI: 10.1038/s41433-020-01273-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The objective of this study is to characterise the natural history of conjunctival naevi in a paediatric and adolescent population. METHODS All children and adolescents referred to Moorfields Ocular Oncology Service for evaluation between January 2015 and 2020 were included. Exclusion criteria included age >20 years old and lack of anterior segment photographs. A total of 77 patients were included with a mean age of 12 years (standard deviation: 3.9; range, 4-20). The main outcome measures were: number of conjunctival naevi that grew, changed in pigmentation, required excisional biopsy, or were histologically malignant. If there was growth, the percentage increase in size was measured. RESULTS At their first visit, 13% of patients (10/77) were discharged to local follow-up and 10% (8/77) proceeded to excisional biopsy, four further patients underwent excisional biopsy after a period of follow-up. On histopathological assessment, 92% (11/12) of lesions were benign conjunctival naevi. One patient, who had suspicious clinical features at presentation, had conjunctival melanoma. Fifty-nine patients were followed over a median of 1.1 years (interquartile range: 1.54; range, 3 months to 4 years). Eight per cent (5/59) of conjunctival naevi enlarged in diameter by a mean percentage increase in size of 2%, whereas 5% (3/59) showed increased pigmentation and 8.5% (5/59) showed decreased pigmentation. CONCLUSIONS Growth of conjunctival naevi in children is infrequent (8%) and the large majority of those excised are benign. Because of a lack of evidence, these patients are often followed for years in ophthalmic practice. This series demonstrates that prolonged follow-up may not be necessary.
Collapse
Affiliation(s)
- Guy S Negretti
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.
| | - Kelsey A Roelofs
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK
| | - Bertil Damato
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK
| | - Mandeep Sagoo
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.,NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Sahar Parvizi
- Department of Ophthalmology, Surrey and Sussex Healthcare NHS Trust, Canada Ave, Redhill, RH1 5RH, UK
| | - Victoria M L Cohen
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.,NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| |
Collapse
|
24
|
Roelofs KA, Mitsopoulos G, Cohen VML. Conjunctival Melanoma with Ipsilateral, Non-Contiguous Eyelid Involvement: A Case Report and Comprehensive Review of the Literature. Ocul Oncol Pathol 2020; 6:333-338. [PMID: 33123526 DOI: 10.1159/000506950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/01/2020] [Indexed: 11/19/2022] Open
Abstract
While the majority of cases of conjunctival melanoma (CM) involve the bulbar conjunctiva, concurrent pigmentation of the ipsilateral eyelid can be seen in up to 15% of cases. Although extension of conjunctival melanoma into the eyelid (AJCC cT3b) occurs in 1% of cases, non-contiguous lesions are very rare with only 5 clearly documented reports in the English literature. Several pathophysiological mechanisms have been proposed, including separate primary melanomas, patchy involvement from primary acquired melanosis (which may be sine pigmento) and exfoliation of malignant tumour cells into the tear film. Herein we present a case of eyelid melanoma arising in a patient previously treated for CM at a non-contiguous site and provide a comprehensive review of the relevant literature.
Collapse
Affiliation(s)
- Kelsey A Roelofs
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | | | - Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom.,NIHR Biomedical Research Centre, UCL Institute of Ophthalmology, London, United Kingdom
| |
Collapse
|
25
|
Keshwani K, Roelofs KA, Hay G, Lewis R, Plowman N. Treating Choroidal Metastases and Improving Vision with Osimertinib in EGFR T790M-Mutated Lung Adenocarcinoma: A Case Report and Review of the Literature. Ocul Oncol Pathol 2020; 7:26-30. [PMID: 33796513 DOI: 10.1159/000510602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
A 41-year-old never-smoking female was diagnosed with epidermal growth factor receptor (EGFR)-mutated T2bN3M1b lung adenocarcinoma with axillary lymph nodes. She complained of blurred vision in the left eye (2/60) and was subsequently found to have a left choroidal metastasis. Treatment with tyrosine kinase inhibitor (TKI) erlotinib was started, and after 1 year of disease stability, she developed unsteadiness and worsening visual disturbance (1/60). Brain imaging showed 24 new brain metastases, which were treated with Gamma Knife stereotactic radiosurgery. An enlarging axillary lymph node was biopsied, which identified the T790M mutation, and she commenced the novel TKI osimertinib. Three weeks later, her choroidal lesion had regressed from 3.1 mm to 2.2 mm, and after 2 months of osimertinib, her visual acuity had improved to 6/9. At the last follow-up 8 months after initiation of osimertinib, her choroidal metastasis remains stable, and visual acuity has improved to 6/6. Evidence suggests that osimertinib's efficacy in treating cerebral metastases is superior to that of chemotherapy and other EGFR-TKIs (gefitinib and erlotinib); however, the literature is sparse with regards to the use of osimertinib for the treatment of intraocular disease. In this case, the need for intense daily radiation treatment with its associated toxicities was negated, and as such we propose that osimertinib may be a promising treatment for choroidal metastasis secondary to EGFR-mutated lung adenocarcinoma.
Collapse
Affiliation(s)
- Karim Keshwani
- Barts Cancer Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Kelsey A Roelofs
- Moorfields Eye Hospital Department of Ocular Oncology, London, United Kingdom
| | - Gordon Hay
- Moorfields Eye Hospital Department of Ocular Oncology, UCL Institute of Ophthalmology and Barts Health NHS Trust, London, United Kingdom
| | - Rachel Lewis
- Barts Cancer Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Nick Plowman
- Barts Cancer Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| |
Collapse
|
26
|
Roelofs KA, O'Day R, Thaung C, Damato B. Intra-Scleral Blue Nevus Arising within Oculodermal Melanocytosis: Melanoma or Not? Ocul Oncol Pathol 2020; 6:275-279. [PMID: 33005617 DOI: 10.1159/000505489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/13/2019] [Indexed: 11/19/2022] Open
Abstract
We report a 61-year-old female who presented to our service with recent growth of a thickened, pigmented, sub-conjunctival lesion within an area of ocular melanocytosis in her left eye. Lamellar sclerectomy was performed. Histopathological assessment revealed a localized melanocytic proliferation with features of blue nevus arising within the area of ocular melanocytosis. There was a small zone of cells showing cytological atypia and expansion of the scleral stroma. We believe this case to be the first report of intrascleral blue nevus arising within an area of ocular melanocytosis. Given the cytological atypia, the blue nevus may perhaps represent an intermediate stage within a progression from ocular melanocytosis towards melanoma. Patients with oculodermal melanocytosis merit regular long-term surveillance for early detection of melanoma, not only in the uvea, but also in the orbit and potentially the ocular surface.
Collapse
Affiliation(s)
- Kelsey A Roelofs
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | - Roderick O'Day
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | | | - Bertil Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| |
Collapse
|
27
|
Ma J, Roelofs KA, Russell L, Weis E, Chen SH. Rapid growth of primary uveal melanoma following intravitreal bevacizumab injection: a case report and review of the literature. Digit J Ophthalmol 2020; 26:27-30. [PMID: 33867879 DOI: 10.5693/djo.02.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Uveal melanoma size is a significant predictor of tumor metastasis. Although the relationship between antivascular endothelial growth factors (VEGF) and uveal melanoma growth has been studied, results are paradoxical, and the relationship remains controversial. We report the case of a 65-year-old man who presented with elevated intraocular pressure in his right eye, neovascularization of his iris, and significant corneal edema, which obscured the view of the angle. Given his history of proliferative diabetic retinopathy, he was diagnosed with neovascular glaucoma and subsequently received an intravitreal injection of bevacizumab and underwent Ahmed valve insertion. This was complicated by postoperative hyphema. Two and a half months postoperatively, a mass involving the inferior iris and ciliary body became visible, and fine-needle aspiration biopsy confirmed uveal melanoma. Seven weeks after diagnosis, the tumor's largest basal diameter had increased from 2.51 mm to 18.0 mm, and apical height increased from 6.23 mm to 11.0 mm. His right eye was enucleated. Histopathological analysis showed discontinuous invasion next to the Ahmed valve. Tumor progression after injection raises the possibility that in some untreated uveal melanomas, accelerated growth may occur following exposure to anti-VEGF agents.
Collapse
Affiliation(s)
- Jingyi Ma
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kelsey A Roelofs
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Laurie Russell
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Ezekiel Weis
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Sylvia H Chen
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
28
|
Ma J, Roelofs KA, Badilla J. Morgellons disease leading to corneal perforation and enucleation. Can J Ophthalmol 2019; 54:e285-e288. [PMID: 31836115 DOI: 10.1016/j.jcjo.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Jingyi Ma
- University of Alberta, Edmonton, Alberta
| | | | | |
Collapse
|
29
|
Ma J, Roelofs KA, Rudnisky CJ. When do you go back to the OR? A case of delayed IOL repositioning after suprachoroidal hemorrhage. Can J Ophthalmol 2019; 54:e225-e227. [PMID: 31564360 DOI: 10.1016/j.jcjo.2019.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Jingyi Ma
- University of Alberta, Edmonton, Alta
| | | | | |
Collapse
|
30
|
Roelofs KA, Starks V, Yoon MK. Reply re: “Orbital Emphysema: A Case Report and Comprehensive Review of the Literature”. Ophthalmic Plast Reconstr Surg 2019; 35:204-206. [DOI: 10.1097/iop.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
Roelofs KA, Aghazadeh H, Cheema M, Weis E, Badilla J. Enucleation and evisceration: an analysis of indications, histopathological findings, and surgical trends over 23 years at a tertiary care hospital in western Canada. Can J Ophthalmol 2019; 54:106-110. [DOI: 10.1016/j.jcjo.2018.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 10/28/2022]
|
32
|
Roelofs KA, Rudnisky CJ. Visual and refractive outcomes following management of anterior capsular tears with a capsulorrhexis relaxing incision. Can J Ophthalmol 2018; 53:533-537. [PMID: 30340724 DOI: 10.1016/j.jcjo.2017.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/12/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the refractive outcomes after anterior capsular tear (ACT). DESIGN Retrospective case-control study. PARTICIPANTS After ethics approval, the surgical operative records of 4301 consecutive patients undergoing cataract surgery by a single surgeon were reviewed for cases of ACT. METHODS All ACTs were managed using a balancing incision of the capsulorrhexis margin 180 degrees away from the tear. If the patient's other eye had undergone cataract surgery by the same surgeon, it was included as a control. RESULTS Fifty-one eyes of 51 patients were complicated by ACT (incidence = 1.2%). The mean age of patients in the study was 64.2 ± 12.1 years. Of the 51 patients with ACT, 34 underwent contralateral surgery. These eyes were used as the control group. There was no significant difference in preoperative visual acuity (p = 0.683) or proportion of eyes that received in-the-bag intraocular lens placement (p = 0.347) between groups (ACT = 92.2%; control = 97.1%). In 3 ACT eyes, the tear extended into the posterior capsule (5.9%), and although this did not occur in control eyes, this difference was not statistically significant (p = 0.150). There was no difference in best-corrected final logMAR visual acuity between groups (p = 0.424) or postoperative spherical equivalent between ACT (-0.23 ± 1.2D) and control (-0.15 ± 0.62D) eyes (p = 0.985). CONCLUSIONS Cataract extraction complicated by ACT can result in equivalent visual and refractive outcomes as in uncomplicated surgery. The technique used in this study prevented extension of ACT to the posterior capsule in 94.1% of cases.
Collapse
Affiliation(s)
- Kelsey A Roelofs
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Chris J Rudnisky
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta..
| |
Collapse
|
33
|
|
34
|
Surakiatchanukul T, Roelofs KA, Shields CL. Acute-Onset Blurred Vision With Shallow Anterior Chamber and Suspected Choroidal Mass. JAMA Ophthalmol 2017; 135:1270-1271. [PMID: 28772304 DOI: 10.1001/jamaophthalmol.2017.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Kelsey A Roelofs
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|