Longitudinal Comparison of Orbital Volumes from Enucleated Eyes with Hydroxyapatite Orbital Implant in Unilateral Retinoblastoma Patients.

PURPOSE: To compare the orbital volume between enucleated and contralateral, uninvolved orbits over a 5-year period in patients with unilateral retinoblastoma who underwent enucleation with hydroxyapatite (HA) implant placement by a single surgeon. METHODS: A retrospective review was performed on the clinical records and radiographic images of unilateral retinoblastoma patients who underwent enucleation with primary HA implantation from 2003 to 2020 at a single institution. Bilateral orbital volume measurements were taken from the initial postoperative MRI scan and again at 1- and 5-years postenucleation. The main outcome measure was the longitudinal change in volume difference (∆𝑉). The implant size, age at enucleation, and sex were also evaluated. A linear mixed-effect model was used for analysis. RESULTS: A total of 124 patients (73 males) with HA implants following enucleation were included. Overall, the unaffected orbit trended toward having a greater volume compared with the enucleated orbit, but this was not statistically significant (ß = 0.003; p = 0.122). The mean age at enucleation was 2.4 years. The median time between enucleation and the initial, 1-year, and 5-year postoperative MRIs was 6 months, 17 months, and 55 months, respectively. There was no statistical correlation between age at enucleation, gender, implant size, or orbital volume at any time points (p > 0.05). CONCLUSIONS: Patients treated with enucleation and primary HA implant placement for unilateral retinoblastoma did not display significant asymmetry in orbital volume on 5-year postenucleation MRIs, suggesting that HA implants promote orbital growth comparable to a nonenucleated orbit in the pediatric population.

Testosterone-Induced Central Serous Chorioretinopathy Mimicking a Choroidal Mass.

PURPOSE: To describe a case of supplemental testosterone-induced central serous chorioretinopathy (CSCR) mimicking a choroidal mass in a 63-year-old male. METHODS: Case report. PATIENT: A 63-year-old male patient on self-prescribed supplemental testosterone with CSCR mimicking a choroidal mass. RESULTS: A 63-year-old male presented with new onset vision loss, subretinal fluid, and choroidal mass in his left eye. Intravenous fluorescein angiography showed an enhancing choroidal mass involving the fovea. B scan ultrasonography revealed diffuse choroidal thickening. Given concern for a diffuse uveal melanoma, the lesion was biopsied showing non-diagnostic rare, atypical melanocytes. Four months after initial presentation, the patient was diagnosed with polycythemia vera. Fourteen months after diagnosis, he admitted to testosterone supplementation. Upon cessation of the testosterone supplement, the lesion progressively flattened to a chorioretinal scar with subretinal fluid resolution, and the return of normal choroidal thickness over the next 14 months. DISCUSSION: Testosterone supplementation has been linked to erythrocytosis and polycythemia vera. In the retina, testosterone supplementation has been linked to CSCR and both central and branch retinal artery and vein occlusions. This case demonstrates the importance of inquiring about all prescribed and over the counter medications in patients presenting with retinal lesions of unknown origin.

An Atypical Presentation of Relapsing Polychondritis Manifesting As Acute Angle Closure.

Relapsing polychondritis (RPC) is a rare autoimmune disease characterized by recurrent inflammation of cartilaginous and proteoglycan-rich tissues throughout the body. The most commonly affected sites are the auricular pinna, nose, and joints with ocular tissue involvement occurring in up to 50% of patients. The most common ocular manifestations are scleritis, episcleritis, uveitis, and conjunctivitis. Less common ocular issues include keratitis, retinopathy, optic neuropathy, extraocular muscle palsy, and orbital inflammation. Due to the variable clinical presentation and rarity of the disease, the diagnosis of RPC is often delayed or it is misdiagnosed. It is important that ophthalmologists be aware of relapsing polychondritis because ocular symptoms may present as the initial manifestation of the disease.

Delayed recurrence of an iridociliary malignant melanoma 180° from the primary tumor.

Purpose: We report the case of a 66-year-old female who returned with a rare recurrence of iridociliary melanoma 180° from the original lesion. Observations: Upon initial presentation eleven years prior, a pigmented iris lesion suspicious for primary uveal melanoma was noted in the right eye at 9 o'clock. After one year of observation, inferior growth of the iris lesion prompted treatment via primary iridectomy with excisional biopsy and pupilloplasty. Postoperative biopsy confirmed spindle B type melanoma with epithelial foci, and adjuvant brachytherapy was performed to treat the reported positive anterior ciliary body involvement. Ten years after initial plaque brachytherapy treatment, the patient returned with a pigmented iris lesion in the right eye at 3:30-5 o'clock, which was treated with enucleation. On pathology, the new melanoma was predominantly epithelioid, consistent with a transformed recurrent iridociliary melanoma. The patient remains metastasis free 13 years after initial diagnosis. Conclusions and importance: This case describes a rare, late recurrence of an iridociliary melanoma 180° away eleven years after initial presentation, emphasizing the importance of lifelong follow-up for patients with iridociliary melanoma. This rare form of recurrence has not been previously reported in the literature. We hypothesize the original lesion contained radiotherapy resistant epithelioid cells which grew superficially on the posterior iris and anterior ciliary body, ultimately breaking back through the anterior iris 180° away.

Adverse reactions to fluorescein angiography: A comprehensive review of the literature.

We reviewed literature on adverse reactions to intravenous fluorescein angiography using PubMed and found 78 articles in English from 1961 to 2017. The reported rates of adverse reactions were overall 0.083-21.69%, separated into mild (1.24-17.65%), moderate (0.2-6%), and severe (0.04-0.59%). There were 1:100,000 to 1:220,000 deaths. Fluorescein concentration, volume injected, speed of injection, temperature, and contaminants were not correlated with the incidence of reactions. Patient characteristics including other comorbid diseases, allergy history, age, race, and gender showed only an increased rate of reaction in patients with a history of reaction to fluorescein. Although a number of studies examine techniques to reduce adverse reactions to intravenous fluorescein angiography, to date, the only proven method is reviewing allergy history, specifically a history of previous reaction to fluorescein.

Demographic, behavioral, and physical correlates of body esteem among low-income female adolescents.

PURPOSE: To examine demographic, behavioral, and physical correlates of body esteem among female adolescents of lower socioeconomic background. METHODS: Data were collected in a women's health clinic in southeast Texas as part of a larger investigation. A total of 271 female individuals aged 16-21 years completed the Body Esteem Scale (BES), which yields scores for total body esteem, sexual attractiveness, weight concern, and physical condition. Participants answered questions regarding smoking and the presence of acne. Height and weight were measured by a nurse using standard instrumentation and technique. Of the participants, 35% were African-American, 31% white, and 34% Hispanic; and 48% reported an annual household income less than $20,000. The mean body mass index (BMI) was 26.1 (SD = 6.5). RESULTS: Race/ethnicity was associated with total body esteem, sexual attractiveness, weight esteem, and physical condition (all p < .01). African-American participants demonstrated greater body esteem on all scales relative to white participants. Adolescents reporting annual household incomes less than $20,000 (vs. greater) demonstrated higher overall body esteem, sexual attractiveness, and physical condition (all p < .01). Current smokers (vs. non-smokers) reported lower physical condition (p < .01), lower weight concern (p < .05), and lower overall body esteem (p < .02). BMI was associated with weight concern (p < .001) and total body esteem (p = .05). Adolescents reporting acne (vs. not) reported lower scores for total body esteem, sexual attractiveness, and weight concern (all p < .05). CONCLUSIONS: Body esteem among adolescent females is affected by demographic, physical, and behavioral variables. Results highlight the importance of measuring multiple dimensions of body esteem.