A Case of Progressive Outer Retinal Necrosis Treated by Combined Intravitreal Foscarnet and Ganciclovir

PURPOSE: To report a case of progressive outer retinal necrosis treated by combined intravitreal foscarnet and ganciclovir. CASE SUMMARY: A 11-year-old male with a history of chemotherapy and cord blood transplantation due to precursor T-cell leukemia developed Herpes zoster lesion on his forehead and rapidly progressing peripheral retinal necrosis without vasculitis in the right eye. Varicella-Zoster virus was confirmed in his cerebrospinal fluid using polymerase chain reaction (PCR); and the patient was diagnosed with progressive outer retinal necrosis. Despite combined treatment with intravenous acyclovir and foscarnet and intravitreal foscarnet, retinal necrosis progressed to retinal detachment and total retinal necrosis. During follow-up, new retinal necrosis was observed in his left eye. The patient was started on combined intravenous and intravitreal foscarnet and ganciclovir; retinal necrosis in the left eye regressed and posterior pole was spared. With subsequent oral valganciclovir and intravitreal foscarnet and ganciclovir, the remaining retina was preserved with maintained vision.

Axial Length Correlation to Lamina Cribrosa Thickness, Prelaminar Tissue Thickness, and Anterior Laminar Displacement

PURPOSE: In this study we determined the correlation of axial length to lamina cribrosa thickness (LCT), prelaminar tissue thickness (PT), and anterior laminar displacement (ALD) in young healthy eyes. METHODS: The optic discs of 60 eyes from 30 young healthy subjects with myopia were scanned using enhanced-depth imaging spectral-domain optical coherence tomography (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany). The LCT, PT, and ALD were measured at the superior midperipheral, middle, and inferior midperipheral of the optic nerve head, respectively. A linear mixed-effects model was used to determine the relationship between the axial length and the LCT, axial length and PT as well as axial length and ALD. RESULTS: The mean, superior midperipheral, and middle LCT were not significantly correlated with axial length. Conversely, the inferior midperipheral LCT was negatively correlated with axial length (p = 0.019, beta = -7.34). There was no significant association between axial length and PT. Mean ALD was negatively correlated with axial length (p = 0.022, beta = -17.17). CONCLUSIONS: In the present study, the inferior midperipheral LCT and mean ALD were negatively correlated with axial length, but PT showed no significant association with axial length.

Primary Squamous Cell Carcinoma of the Orbit

PURPOSE: Normal squamous cells do not exist in the orbit. Therefore squamous cell carcinoma of the orbit is rare and usually arises as a secondary tumor from distant metastasis or local invasion. The authors herein describe the first case of primary squamous cell carcinoma of the orbit in Korea. CASE SUMMARY: A 74-year-old female presented with a 2-month history of left upper eyelid swelling and ocular pain. On physical examination, a round, firm, fixed and tender mass was palpable in the superomedial side of the left orbit. Magnetic resonance imaging (MRI) showed 21 mm x 15 mm x 20 mm-sized irregular soft tissue mass with indistinct margin and peripheral enhancement in the superomedial portion of the left orbit, and incisional biopsy of the mass was performed. Histopathological examination showed clusters of squamous cells with polymorphic nuclei and interspersed keratin pearls, consistent with findings of well-differentiated squamous cell carcinoma. Despite extensive systemic work-up, there was no sign of extraorbital malignancy. The patient received left exenteration and adjuvant radiation therapy. Ten months after enucleation, a 12 mm x 14 mm sized firm mass developed on the left forehead, and excisional biopsy and frontalis rotational flap reconstruction were performed. Histopathological examination of the mass was consistent with well-differentiated squamous cell carcinoma. The patient remained alive 17 months after diagnosis without evidence of local recurrence or distant metastasis. CONCLUSIONS: Primary squamous cell carcinoma should be considered in the differential diagnosis of acutely progressing tumors of the orbit.