ABSTRACT
Surgical repair of orbital fractures with implants is a widely used treatment modality. While a variety of established complications are associated with this technique, most are directly understood and treated. Bloody epiphora is a finding with potentially ominous causes. The authors present a unique case of bloody epiphora, accompanied by orbital hemorrhage arising several years after orbital floor fracture repair, due to erosion of the nasolacrimal drainage system by a displaced implant combined with anticoagulation. The collection and evaluation of all protected patient health information was compliant with the regulations and conditions set forth in the Health Insurance Portability and Availability Act of 1996.
Subject(s)
Lacrimal Apparatus Diseases/etiology , Orbital Fractures/complications , Orbital Implants/adverse effects , Postoperative Hemorrhage/etiology , Decompression, Surgical/methods , Female , Follow-Up Studies , Humans , Lacrimal Apparatus Diseases/diagnosis , Lacrimal Apparatus Diseases/surgery , Middle Aged , Orbital Fractures/diagnosis , Orbital Fractures/surgery , Postoperative Hemorrhage/diagnosis , Postoperative Hemorrhage/surgery , Time Factors , Tomography, X-Ray ComputedABSTRACT
PURPOSE: This study evaluates the prognostic performance of a 15 gene expression profiling (GEP) assay that assigns primary posterior uveal melanomas to prognostic subgroups: class 1 (low metastatic risk) and class 2 (high metastatic risk). DESIGN: Prospective, multicenter study. PARTICIPANTS: A total of 459 patients with posterior uveal melanoma were enrolled from 12 independent centers. TESTING: Tumors were classified by GEP as class 1 or class 2. The first 260 samples were also analyzed for chromosome 3 status using a single nucleotide polymorphism assay. Net reclassification improvement analysis was performed to compare the prognostic accuracy of GEP with the 7th edition clinical Tumor-Node-Metastasis (TNM) classification and chromosome 3 status. MAIN OUTCOME MEASURES: Patients were managed for their primary tumor and monitored for metastasis. RESULTS: The GEP assay successfully classified 446 of 459 cases (97.2%). The GEP was class 1 in 276 cases (61.9%) and class 2 in 170 cases (38.1%). Median follow-up was 17.4 months (mean, 18.0 months). Metastasis was detected in 3 class 1 cases (1.1%) and 44 class 2 cases (25.9%) (log-rank test, P<10(-14)). Although there was an association between GEP class 2 and monosomy 3 (Fisher exact test, P<0.0001), 54 of 260 tumors (20.8%) were discordant for GEP and chromosome 3 status, among which GEP demonstrated superior prognostic accuracy (log-rank test, P = 0.0001). By using multivariate Cox modeling, GEP class had a stronger independent association with metastasis than any other prognostic factor (P<0.0001). Chromosome 3 status did not contribute additional prognostic information that was independent of GEP (P = 0.2). At 3 years follow-up, the net reclassification improvement of GEP over TNM classification was 0.43 (P = 0.001) and 0.38 (P = 0.004) over chromosome 3 status. CONCLUSIONS: The GEP assay had a high technical success rate and was the most accurate prognostic marker among all of the factors analyzed. The GEP provided a highly significant improvement in prognostic accuracy over clinical TNM classification and chromosome 3 status. Chromosome 3 status did not provide prognostic information that was independent of GEP.
Subject(s)
Biomarkers, Tumor/genetics , Gene Expression Profiling , Melanoma/genetics , Uveal Neoplasms/genetics , Adolescent , Adult , Aged , Aged, 80 and over , Chromosomes, Human, Pair 3/genetics , Female , Follow-Up Studies , Gene Expression Regulation, Neoplastic/physiology , Humans , Male , Melanoma/pathology , Middle Aged , Oligonucleotide Array Sequence Analysis , Polymorphism, Single Nucleotide , Prognosis , Prospective Studies , Real-Time Polymerase Chain Reaction , Uveal Neoplasms/pathology , Young AdultABSTRACT
A broad spectrum of lymphomas can affect the eye and orbital tissues. This article discusses those that affect the orbit, lids, lacrimal gland, and conjunctiva.
