Islam Y. Swaify

INTRODUCTION: We aim to explore the safety and efficacy of episcleral brachytherapy as a primary management option for eyes with retinal pigment epithelial (RPE) adenoma.

METHODS: Retrospective chart review of the demographic, clinical, ancillary, and postoperative outcome data of patients with RPE adenoma in 2 tertiary referral centers. Tumor regression, final visual acuity, and complications were assessed.

RESULTS: Five patients (3 females and 2 males) were included. Four of the 5 eyes had peripheral and mid-peripheral lesions, while one tumor was juxtapapillary. Three eyes were treated with ruthenium-106 (100 Gray), and 2 received iodine-125 episcleral plaques (85 Gray). All eyes showed clinical and imaging-based evidence of regression. Four eyes had stable or improved visual acuity, while 1 eye exhibited one line loss of visual acuity due to radiation retinopathy. Local recurrence was not observed in any eye over a median follow-up of 24 (range 6-112) months.

CONCLUSIONS: Episcleral brachytherapy is an effective management option for select cases of RPE adenoma that is capable of achieving tumor regression while maintaining favorable visual acuity. The initial safety profile of brachytherapy is good without significant vision-compromising complications.

Introduction: We aim to report the anatomical and functional outcomes of ruthenium-106 brachytherapy in the management of circumscribed choroidal hemangiomas (CCH). Methods: This is a single-center, retrospective case series including patients with unilateral symptomatic CCH treated with ruthenium-106 brachytherapy at the Cairo University Ocular Oncology Service. Patient records were analyzed for patients’ demographics, best corrected visual acuity (BCVA), tumor dimensions (thickness and largest base diameter), foveal subretinal fluid, radiation-related complications, and recurrence. Results: Seven patients were included in the study (including 6 males) with a mean age of 39.3 ± 15.4 years; ruthenium-106 plaque was used to deliver 50 Gray to the tumor apex. After a mean follow-up duration of 12.5 months, all patients had significant improvement in BCVA after treatment, mean tumor height decreased significantly from 4.76 ± 1.76 mm to 1.70 ± 1.2 mm (p value 0.01). The largest tumor base diameter also decreased significantly from 9.13 ± 2.68 mm to 4.65 ± 3.75 mm (p value 0.05). Subretinal fluid and exudative retinal detachment resolved in all patients, and no significant radiation-related complications were observed in any patient. None of the patients needed any further treatment or experienced recurrence within the follow-up period. Conclusion: Ruthenium-106 brachytherapy is an effective tool in the management of symptomatic CCH with a good visual prognosis and safety profile.

PURPOSE: To assess the efficacy and safety of periocular injections of methotrexate versus triamcinolone in the management of active thyroid-associated orbitopathy.

STUDY DESIGN: Prospective, double-masked, randomized clinical trial.

METHODS: Participants with bilateral active, moderate-to-severe thyroid-associated orbitopathy were randomly assigned to receive three periocular injections of 7.5 mg methotrexate in one orbit and three periocular injections of 20 mg triamcinolone in the contralateral orbit.

RESULTS: Among the enrolled 25 patients, 18 patients completed the study. A statistically significant reduction of the mean clinical activity score was detected in both arms (from 5.2 ± 0.89 at baseline to 0.9 ± 1.7 at study endpoint, p-value < 0.001 in the methotrexate arm, and from 5.1 ± 0.9 at baseline to 1 ± 1.7 at study endpoint, p-value < 0.001 in the triamcinolone arm), mean proptosis also decreased in both arms (from 25.2 ± 3.4 mm at baseline to 23.8 ± 3.7 mm at study endpoint, p-value = 0.01 in the methotrexate arm, and from 24.2 ± 3.06 mm at baseline to 23.2 ± 3.3 mm at study endpoint, p-value = 0.049 in the triamcinolone arm). Lid aperture and soft tissue signs improved significantly in both arms in comparison to baseline. A statistically significant reduction in the intraocular pressure was observed in the methotrexate arm but not in the triamcinolone arm. 88.9% of patients in both arms were overall responders at 6 months. There was no significant difference in mean CAS, proptosis, lid aperture or rate of responders between the two arms at any visit. Both drugs were found to be safe with minimal local and systemic complications.

CONCLUSION: Periocular injections of methotrexate represent an effective and safe alternative option for the management of active, moderate-to-severe thyroid-associated orbitopathy. Although no serious complications occurred during the 6-month follow-up, the possibility of late complications such as orbital fat atrophy cannot be ruled out.

Adenoma and adenocarcinoma, are two uncommon acquired true neoplasms of the RPE. They highly mimic uveal melanomas which carry high risk of metastasis so it is critical to recognize RPE tumors and distinguish them from melanomas.

The majority of RPE neoplasms present as a dome shaped elevated darkly pigmented lesion. The presence of exudative retinal detachment, yellow intraretinal exudation around the mass as well as the presence of a feeding artery and a draining vein are among the distinguishing features from uveal melanomas. Acquired RPE neoplasms are usually peripheral however, peripapillary RPE neoplasms has been reported.

Among the management options for the small sized RPE tumors below 4 mm in thickness are cryotherapy or transpupillary thermotherapy. For larger tumors; PDT, partial lamellar sclerouvectomy or external beam irradiation were recommended.

Recently, Episcleral Brachytherapy has been addressed to be an effective primary management plan with minimal long term complications in cases of RPE adenoma.

Retinoblastoma is the most common malignant intraocular tumor in childhood and accounts for 3% of all childhood cancers, with an incidence of approximately 1 in 17,000 live births, and approximately 8000 new cases are diagnosed each year worldwide. Despite the great advances in retinoblastoma management modalities, with survival rates reaching up to 95%–98% in developed countries, early diagnosis still represents a challenge in developing countries, resulting in a longer lag time in diagnosis and lower survival rates. This review article aims to highlight the various retinoblastoma presentations and shed light on possible retinoblastoma mimickers. Accurate differentiation between retinoblastoma and conditions that mimic retinoblastoma is crucial for proper management, and a high index of suspicion is therefore necessary for a proper and prompt diagnosis of retinoblastoma cases, which is the key to decreasing morbidity and mortality.

To investigate the demographic data & interventional clinical outcomes of patients presenting to the new Cairo University ocular oncology service with uveal melanomas. This was a retrospective analysis of the medical records of patients managed for choroidal & ciliochoroidal melanomas. We reviewed the demographic data & different management modalities, compared the ultrasound measurements of the tumors before and after intervention and analyzed the complications & failure rates. 41 eyes of 41 patients were included. 30 eyes were managed with episcleral Ruthenium-106 plaque radiotherapy, or brachytherapy, of which four eyes were considered failures. One of the four eyes developed a rhegmatogenous retinal detachment & endophthalmitis necessitating pars plana vitrectomy that ended in exenteration due to extrascleral extension, while the remaining three eyes were enucleated due to progression in the tumor dimensions, demonstrating a failure rate of 13.3%. 10 of the remaining 11 eyes were enucleated based on the large baseline tumor size, while the eleventh eye showed extrasceleral extension necessitating exenteration. The mean age of the brachytherapy group was 56.4 +/- 12.1 years, while the enucleation & exenteration group was 50.2 +/-11.5 years (p = 0.18). Mean baseline dimensions for the brachytherapy group was 5.52 +/-2.1 mm height & 9.42 +/-3.2 mm diameter, while the enucleation group was 10.52 +/-3.49 mm height & 13.79 +/- 3.18 mm diameter. (p <0.001 & <0.01, respectively). For the brachytherapy group, the mean duration of plaque application was 7.02 +/- 4.06 days & the mean delivered radiation dose was 113.34 +/-5.3 Grey. Mean final sonographic follow up periods for the brachytherapy group was 26.4 +/- 16.16 weeks, with the mean height at 4.83 +/- 2.4 mm & base diameter at 8.12 +/- 3.36 mm. (p = 0.24 & 0.182, respectively). None of the patients demonstrated metastatic spread on serial Pan or PET/CT. Timely referral & accurate clinical & investigative assessment of cases with uveal melanomas are invaluable for achieving higher success rates of tumor regression, as well as ocular and/or visual preservation in eyes managed with brachytherapy. Patients with more advanced tumors should be counseled on the importance of more invasive techniques, such as enucleation & exenteration for achieving lower malignancy dissemination & mortality rates. This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

AimThis study investigated the correlation between chalazion, regarding its size, site and location, and different types of refractive errors, as well as high-order aberrations in Egyptian patients.Patients and methodsThis is a cross-sectional study which compared 53 eyes from 48 patients having eyelid chalazion with 43 eyes of age-matched control group. Chalazion was classified according to size, site, and location. Refraction was done using an autorefractokeratometer. Corneal topography and aberrations were done using a Scheimpflug topographer.ResultsThe third-order aberration (coma Z31) and fourth-order aberration (secondary astigmatism Z42) were higher in the chalazion group compared with the control group (P=0.035 and 0.035, respectively). Lower lid chalazia showed higher Esafoil aberration Z66 than both upper lid and control group (P=0.015 and 0.001, respectively). In addition, the large-sized chalazion group showed a significant increase in Esafoil aberration Z66 than the small-sized group and the control group (P=0.004 and 0.003, respectively). No difference was observed between the chalazion group and the control group regarding autorefractokeratometer data or topographic data.ConclusionAlthough the presence of chalazion may not be associated with changes in refraction or corneal astigmatism, it still can cause increase in some high-order aberrations and hence, in the quality of vision. Besides, it is a threat as a source of infection before any surgical procedure. Therefore, it is important to exclude and treat any chalazion before proceeding with any refractive surgery especially wave-front-guided and wave-front-optimized corneal refractive procedures.

Spheroidal degeneration, involving the cornea and/or the conjunctiva, is characterized by amber-colored homogeneous, translucent spherules in the corneal stroma, Bowman's membrane, and subepithelium. The condition has a higher prevalence in areas with extreme temperatures, low humidity, high wind, and presence of sand. We report the case of a 46-year-old man with a 10-year history of gradual progressive diminution of vision, severe blepharospasm, and photophobia. Examination revealed bilateral plaques of amber-colored nodules covering about half of the cornea. Superficial keratectomy was performed for the lesions in both eyes, leaving an epithelial defect overlying a plane of opaque cornea. Histopathology showed amorphous protein in the anterior stroma, confirming the clinical diagnosis of advanced grade 4 spheroidal degeneration. Visual acuity and other symptoms dramatically improved, and the patient was scheduled for keratoplasty.