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Parikh DA, Mellen PL, Kang T, Shalaby WS, Moster MR, Dunn JP. Gonioscopy-Assisted Transluminal Trabeculotomy for the Treatment of Glaucoma in Uveitic Eyes. Ocul Immunol Inflamm 2023; 31:1608-1614. [PMID: 35695409 DOI: 10.1080/09273948.2022.2087093] [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: 07/13/2021] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in adult eyes with uncontrolled uveitic glaucoma. METHODS We reviewed 16 eyes from 13 patients. Surgical success was defined as intraocular pressure (IOP) reduction >20% from baseline or IOP between 5 and 21 mmHg by the 3-month visit while on a stable number or fewer IOP-lowering agents and no need for additional glaucoma surgery. RESULTS At 12 months, the cumulative success rate was 81%. Mean IOP was 37.8 ± 13.0 mmHg at baseline and 12.2 ± 3.0 mmHg at 12 months (68% reduction; p < .0001). The average number of glaucoma medications was 4.6 ± 1.3 at baseline and 2.2 ± 0.7 at 12 months (52% reduction; p < .0001). Transient hyphema was seen in 44% of eyes at 1 week. CONCLUSIONS This small retrospective study suggests that GATT is effective and safe as an initial surgical treatment for medically refractory glaucoma in uveitic adult eyes.
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Affiliation(s)
- Devayu A Parikh
- Uveitis Unit, Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Phoebe L Mellen
- Uveitis Unit, Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Tony Kang
- Uveitis Unit, Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Marlene R Moster
- Glaucoma Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - James P Dunn
- Uveitis Unit, Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Mellen PL, Heier JS. Gene Therapy for Neovascular Macular Degeneration, Diabetic Retinopathy, and Diabetic Macular Edema. Int Ophthalmol Clin 2021; 61:229-239. [PMID: 34584059 DOI: 10.1097/iio.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mellen PL, Obeid A, Wibbelsman TD, Hsu J, Konkoly MA, Velez MR, Calem DB, Sioufi K, Jenkins TL, Xu D, Chiang A, Gupta OP, Spirn M, Regillo CD, Ho AC, Klufas MA. Clinical Outcomes of Eyes With Diabetic Macular Edema Switched From Aflibercept to Ranibizumab Therapy. Ophthalmic Surg Lasers Imaging Retina 2020; 51:691-697. [PMID: 33339050 DOI: 10.3928/23258160-20201202-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE In 2018, cases of inflammation were reported after intravitreal aflibercept (IVA), which resulted in switches to intravitreal ranibizumab (IVR). The authors' purpose was to evaluate outcomes after switching from IVA to IVR in diabetic macular edema (DME). PATIENTS AND METHODS Retrospective cohort study. Eyes switched from IVA to IVR for treating DME were included. Data were gathered from three visits before to three visits post-switch. Outcome measures included central subfoveal thickness (CFT) and Snellen visual acuity (VA). RESULTS There was a statistically significant increase in CFT at the first visit (325 μm ± 234 μm; P = .006) compared to the switch visit, but no difference later visits (268 μm ± 103 μm; P = .32; 284 μm ± 118 μm; P = .11; n = 54). There was no statistically significant change in mean logarithm of the minimum angle of resolution VA between the switch and later visits (0.43 ± 0.38, P = .95; 0.38 ± 0.30, P = .12; 0.41 ± 0.37, P = .69). CONCLUSIONS The authors observed transient worsening of macular edema in eyes treated for DME when switched from aflibercept to ranibizumab. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:691-697.].
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Abstract
PURPOSE To report a patient with clinically invisible retinal astrocytic hamartomas (RAHs) detected on optical coherence tomography (OCT) and studied with OCT angiography (OCTA). METHOD Case report. RESULTS An 11-year-old healthy girl was evaluated for reduced visual acuity in the right eye. On examination, best-corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundus examination revealed blunted foveal reflex in the right eye and normal findings in the left eye. Optical coherence tomography disclosed an abruptly elevated, honeycomb-like macular mass with thin filamentous walls in the right eye, limited to the nerve fiber layer and measuring 756 μm in thickness. The numerous intralesional cavities (optically empty spaces) displayed no calcification. These findings were consistent with Type IV RAH. Optical coherence tomography of the left eye revealed intact foveola and focal nerve fiber layer thickening inferiorly without cavity, measuring 136 μm in thickness, consistent with Type I RAH. En face OCTA detected microvascular flow within the walls of the cavitary RAH in the right eye. Bilateral RAH in a child with no systemic evidence of tuberous sclerosis syndrome was established. CONCLUSION Multimodal imaging is important in revealing causes of visual loss and in the detection of subclinical fundus tumors. In this case, clinically invisible RAHs were detected only by OCT and surrounding vascular flow by OCTA.
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Affiliation(s)
- Phoebe L Mellen
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Wibbelsman TD, Pandit RR, Xu D, Jenkins TL, Mellen PL, Soares RR, Obeid A, Levin H, Hsu J, Ho AC. Trends in Retina Specialist Imaging Utilization from 2012 to 2016 in the United States Medicare Fee-for-Service Population. Am J Ophthalmol 2019; 208:12-18. [PMID: 31265802 DOI: 10.1016/j.ajo.2019.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterize temporal trends and regional variance in retinal imaging utilization in the United States Medicare fee-for-service population from 2012-2016. DESIGN Cross-sectional, retrospective database analysis. METHODS This study addresses office or operating-room based retinal imaging. Our study population included retina specialists, defined as ophthalmologists performing either intravitreal anti-vascular endothelial growth factor injections or posterior segment laser photocoagulation and no neodymium-doped yttrium aluminum garnet laser capsulotomy. We recorded fundus photography, optical coherence tomography (OCT), intravenous fluorescein angiography (IVFA), indocyanine-green angiography, and ophthalmic ultrasound (B-scan) billed in the Medicare fee-for-service population from 2012-2016. Imaging obtained on any platform or device was eligible for inclusion (eg, posterior pole imaging vs ultrawidefield imaging). The main outcome measure was the relative utilization of retinal imaging modalities. RESULTS National relative utilization of OCT increased from 61.5% in 2012 to 70.5% in 2016 (P < .001), while IVFA fell from 20.9% to 15.1% over the same interval (P < .001). Fundus photography decreased from 14.6% in 2012 to 11.7% in 2016 (P < .001). By 2016, the Midwest region had the highest relative utilization of OCT (75.2%) and lowest of IVFA (12.0%), while the West region had the lowest OCT (68.4%) and highest IVFA (17.0%). CONCLUSIONS Among retina specialists, OCT usage increased while the utilization of fundus photography and IVFA has declined. The Midwest region had the highest utilization of OCT and lowest of IVFA.
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Affiliation(s)
| | - Ravi R Pandit
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - David Xu
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Thomas L Jenkins
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Phoebe L Mellen
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Rebecca R Soares
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Anthony Obeid
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Hannah Levin
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Allen C Ho
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
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Gervasio KA, Mellen PL, Boparai RS, Soares RR, Fastenberg J, Chaskes M, Rabinowitz MP, Rabinowitz MR. Combined Endoscopic and External Resection of an Inverted Papilloma of the Lacrimal Sac: A Case Report and Review of the Literature. Allergy Rhinol (Providence) 2019; 10:2152656719876254. [PMID: 31555491 PMCID: PMC6747856 DOI: 10.1177/2152656719876254] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Inverted papillomas (IPs) are benign, locally aggressive neoplasms with a high recurrence rate that most commonly arise from the lateral nasal wall. Rarely, IP can originate from the lacrimal sac and/or nasolacrimal duct (NLD) system. A 58-year-old man presented with chronic epiphora and an enlarging mass inferior to his left medial canthal tendon (MCT) for 2 years. Objective The patients’ clinical presentation and surgical management are described. A literature review on IP of the lacrimal sac and NLD system was conducted. Methods Case report. Results We present a case of an IP that arose primarily from the lacrimal sac and grew below the MCT rather than extending above it. This is one of few published case reports detailing the use of a combined endoscopic and external approach for the resection of an IP of the lacrimal sac. Conclusion Combined endoscopic and external resection is a viable approach for complete removal of extensive IP of the lacrimal sac and NLD system. IP arising from the lacrimal sac may grow below the MCT or extend above it as previously reported.
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Affiliation(s)
- Kalla A Gervasio
- Department of Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Phoebe L Mellen
- Department of Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Ranjodh S Boparai
- Department of Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Rebecca R Soares
- Department of Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Judd Fastenberg
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark Chaskes
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael P Rabinowitz
- Department of Oculoplastic and Orbital Surgery, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Mindy R Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Talcott KE, Adam MK, Sioufi K, Aderman CM, Ali FS, Mellen PL, Garg SJ, Hsu J, Ho AC. Comparison of a Three-Dimensional Heads-Up Display Surgical Platform with a Standard Operating Microscope for Macular Surgery. Ophthalmol Retina 2018; 3:244-251. [PMID: 31014702 DOI: 10.1016/j.oret.2018.10.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/17/2018] [Accepted: 10/26/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess safety, efficacy, and outcomes of vitreoretinal surgery for macular pathology using a 3-dimensional heads-up display (3D HUD) surgical platform compared with a standard operating microscope (SOM). DESIGN Prospective, single-center, unmasked, randomized study. PARTICIPANTS Patients undergoing pars plana vitrectomy (PPV) for epiretinal membrane (ERM) or full-thickness macular hole (MH) at Wills Eye Hospital. METHODS Patients were randomized 1:1 to undergo surgery with a 3D HUD surgical platform or SOM. Patients who had previous PPV were excluded. Surgical choices, including PPV gauge, were based on surgeon preference. Standard surgical safety parameters, Early Treatment Diabetic Retinopathy Study visual acuity (VA), minimum required endoillumination levels, operative times, and surgeon "ease of use" of the viewing platform were recorded. Patients were followed up to postoperative month 3 (POM3). MAIN OUTCOME MEASURES The main outcome measures were total operative time, macular peel time, surgeon rating of viewing system ease of use, minimum required endoillumination, intraoperative complication rate, and postoperative VA. RESULTS Thirty-nine eyes of 39 patients with a mean age of 67.60±8.21 SD years were enrolled. Indications included ERM (n = 26 [3D HUD = 14, SOM = 12]) and MH (n = 13 [3D HUD = 9, SOM = 4]). Minimum required endoillumination was significantly lower with 3D HUD (mean 22.70%±15.10% SD) compared with SOM (mean 39.06%±2.72%; P < 0.001). There was no significant difference in overall operative time, but macular peel time was significantly longer using 3D HUD (mean 14.76±4.79 minutes) than SOM (11.87±8.07 minutes; P = 0.004). Surgeon-reported ease of use was significantly higher (easier) using SOM compared with 3D HUD (P = 0.004). There was no statistically significant difference between the groups in POM3 logarithm of the minimum angle of resolution (logMAR) VA or change in logMAR VA from baseline (all P > 0.681). There were no clinically significant intraoperative complications in either group. CONCLUSIONS Three-dimensional heads-up display surgical visualization is an evolving technology demonstrating comparable efficacy to the SOM for macular surgery. Although overall surgical times were similar, 3D HUD macular peel times were longer and associated with less ease of use in this study, which may partly be due to a learning curve with new technology.
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Affiliation(s)
- Katherine E Talcott
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | | | - Kareem Sioufi
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Christopher M Aderman
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Ferhina S Ali
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Phoebe L Mellen
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sunir J Garg
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jason Hsu
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Allen C Ho
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania.
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Shields CL, Regillo AC, Mellen PL, Kaliki S, Lally SE, Shields JA. Giant conjunctival nevus: clinical features and natural course in 32 cases. JAMA Ophthalmol 2013; 131:857-63. [PMID: 23702735 DOI: 10.1001/jamaophthalmol.2013.160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Conjunctival nevus is the most common tumor of the ocular surface and we selected the largest nevi to evaluate for clinical features and outcomes. OBJECTIVE To describe the clinical features and outcomes of giant (≥10 mm diameter) conjunctival nevus. DESIGN, SETTING, AND PATIENTS Retrospective case series of 618 patients with conjunctival nevus, 32 of which had giant conjunctival nevus, treated at an ocular oncology service between July 1, 1974, and June 30, 2012. EXPOSURES Observation, excisional biopsy, and cryotherapy. MAIN OUTCOMES AND MEASURES Management, nevus recurrence, and nevus transformation into melanoma. RESULTS Of 618 patients with conjunctival nevus, 32 (5%) were classified as having giant conjunctival nevus. The mean patient age at diagnosis was 34 years. Of those with giant conjunctival nevus, a history of an increase in nevus base or thickness was noted in 15 cases (47%) and an increase in color intensity in 2 cases (6%). The giant nevus involved cornea in 11 cases (34%), limbus in 23 (72%), bulbar conjunctiva in 31 (97%), fornix in 9 (28%), tarsus in 3 (9%), semilunar fold in 10 (31%), and caruncle in 7 (22%). The nevi had mean diameter of 16 mm and mean thickness of 2 mm. On slitlamp examination, intrinsic cysts were identified in 25 cases (78%), intrinsic blood vessels in 26 (81%), and feeder vessels in 22 (69%). Management included excisional biopsy with cryotherapy in 23 cases (72%) and observation in 9 cases (28%). Amniotic membrane graft reconstruction was used following excision in 3 cases (13%). Malignant melanoma developed within the giant nevus in 1 case after 23 years of observation. Postexcisional biopsy, nevus recurrence was detected in 4 cases (17%), pseudopterygium in 1 (4%), dry eye in 1 (4%), and eyelid blepharoptosis in 1 (4%). CONCLUSIONS AND RELEVANCE In an ocular oncology practice, giant conjunctival nevus represents 5% of conjunctival nevi. This benign tumor rarely transforms into conjunctival melanoma. Management alternatives include observation or wide excisional biopsy, cryotherapy, and reconstruction, possibly with amniotic membrane graft.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Abstract
In January 2010, the American Joint Committee on Cancer (AJCC) updated its staging criteria for uveal melanoma. Here, we discuss the staging classifications and evaluate an interesting case to demonstrate. The development of a uniform means of staging cancer, such as defined by the AJCC, is critical for information sharing among the research community.
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Affiliation(s)
- Phoebe L. Mellen
- Department of Ocular Oncology, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Spenser J. Morton
- Department of Ocular Oncology, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L. Shields
- Department of Ocular Oncology, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Shields CL, Ramasubramanian A, Mellen PL, Shields JA. Conjunctival Squamous Cell Carcinoma Arising in Immunosuppressed Patients (Organ Transplant, Human Immunodeficiency Virus Infection). Ophthalmology 2011; 118:2133-2137.e1. [DOI: 10.1016/j.ophtha.2011.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 02/25/2011] [Accepted: 04/01/2011] [Indexed: 10/18/2022] Open
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Ramasubramanian A, Shields CL, Mellen PL, Haji S, Harmon SA, Vemuganti GK, Shields JA. Autofluorescence of treated retinoblastoma. J AAPOS 2011; 15:167-72. [PMID: 21596295 DOI: 10.1016/j.jaapos.2010.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/24/2010] [Accepted: 12/24/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe the autofluorescent features of retinoblastomas after treatment. METHODS Standard fundus photography and autofluorescence (AF) photography (580 nm excitation, 695 nm barrier filter) were performed on 88 tumors of 61 patients. Clinical features were correlated with autofluorescent features. RESULTS The mean patient age at AF was 10.3 years. Of the 88 tumors, 5 (6%) were untreated, and 83 (94%) were treated. The untreated retinoblastomas showed hyperautofluorescence (hyperAF) at the site of calcification in all 5 cases (100%). The treated retinoblastomas showed intrinsic calcification in 54 cases (65%) and bright hyperAF at the site of calcification was detected in all cases. Of the 60 tumors with noncalcified remnant, the noncalcified portion was mildly hyperAF in 20 (33%), isoautofluorescence in 31 (52%), and mildly hypoautofluorescence (hypoAF) in 9 (15%). Surrounding retinal pigment epithelium hyperplasia appeared moderately hypoAF in 58 of 58 eyes (100%). Retinal pigment epithelium atrophy appeared mildly hyperAF in 29 (37%), isoautofluorescence in 33 (42%), and mildly hypoAF in 16 (21%). CONCLUSIONS AF of retinoblastoma generally shows bright hyperAF of the calcified portion and variable AF of the noncalcified portion. The AF of calcification in retinoblastoma was confirmed by fluorescent microscopy of unstained sections of retinoblastoma after enucleation.
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